First described in 2001, various groups have utilized the da Vinci system in colectomies for benign and malignant disease. Weber, et al described three robotic right and sigmoid colectomies using the da Vinci system in 2002. The largest series to date is described by D’Annibale who reported 53 robotic colorectal surgeries from May 2001 to May 2003 where 23 cases of malignant colorectal disease were confirmed. The authors concluded that the robotic assisted laparoscopic surgery was a safe and viable alternative to standard laparoscopic techniques. The first combined transthoracic and transabdominal robotic-assisted esophagectomy with cervical esophagogastric anastomosis was described in 2004. The operation was performed in two stages under one period of general anesthesia. The patient was initially placed in the left-lateral position with single lung ventilation of the left lung. The thoracic portion of the procedure was performed using five port sites in the right chest. The total operative time was 11 hours with surgical robotic console time logged at 4 hours and 20 minutes. The postoperative recovery was described as uneventful. The authors concluded that the robotic-assisted surgery is a safe alternative and does not compromise the oncologic principles or staging accuracy for gastric cancer. The advantages and disadvantages of robotic surgery and natural orifice transluminal endoscopic surgery are listed in this chapter.