Intraoperative adverse events (IAEs) during robot-assisted minimally invasive esophagectomy (RAMIE) can occur in about 8.6% of cases, but most are managed robotically without conversion to open surgery.

• 41 patients experienced IAEs, with bleeding being the most common (69.6% of events).
• Major IAEs (4.2% of cases) led to significantly increased blood loss (average 1211 ml vs. 296 ml), higher conversion rates (15.0% vs. 1.3%), and longer operative times (478.6 vs. 413.3 min).

Despite the occurrence of these events, there was no significant increase in postoperative complications, hospital stays, or mortality, suggesting that robotic assistance may effectively facilitate management of IAEs.