Fully robotic da Vinci Ivor–Lewis esophagectomy in four-arm technique—problems and solutions

Abstract

The aim of this technical note is a step-by-step description of a fully robotic abdominothoracic esophagectomy with an intrathoracic esophagogastrostomy. We report on our technique and short-term results of 75 patients undergoing an Ivor-Lewis esophagectomy using a fully robotic 4-arm approach in the abdominal and thoracic phase with a hand-sewn intrathoracic anastomosis. There are several important steps and differences to consider compared to the conventional minimal invasive approach (patient's positioning, anaesthesiological set up, port placement, gastric conduit pull up, technique of esophagostrostomy). Mean operative time was 392 minutes (240-610) with a 94% R0 resection status. Conversion to open procedure occurred in 2 (2.6%) in the abdominal, and 14 (18.2%) in the thoracic phase. Main reasons for conversion were problems during the lifting of the gastric conduit and difficulties in the construction of the esophagogastrostomy. The rate dropped during the last 20 patients (1/20 (10%). Our results suggest that the reported technique is safe and feasible. It satisfies the oncological principles and provides the advantages of robotic assisted minimal invasive surgery.

Recent advancements in esophageal cancer treatment in Japan

“…Conversion to open procedure occurred in two (2.6%) patients in the abdominal and 14 patients (18.7%) in the thoracic phase. Main reasons for conversion were problems during lifting of the gastric conduit and difficulties in the construction of the esophagogastrostomy . In Japan, however, Nakauchi et al reported on the initiation in 2009 of robotic gastrectomy and esophagectomy for patients with upper gastrointestinal cancer, and they showed potential advantages of the da Vinci Surgical System in reducing postoperative local complications after gastrectomy and recurrent laryngeal nerve palsy after esophagectomy.…”

Robot-assisted minimally invasive esophagectomy (RAMIE) improves perioperative outcomes: a review

“…By translating the surgeon's natural hand movements on the console to the surgical instruments with endo-wrists, a robotic system can achieve a large range of motion that enables manual suturing. Several case series have been published, which suggest that a robot-assisted hand-sewn intrathoracic anastomosis is safe and feasible for RAMIE (39)(40)(41). Prospective randomized studies are warranted to investigate hand-sewing versus stapling in terms of anastomotic leakage and benign stricture formation after RAMIE with an intrathoracic anastomosis.…”

Feasibility of Transcervical Robotic-Assisted Esophagectomy (TC-RAMIE) in a Cadaver Study—A Future Outlook for an Extrapleural Approach

“…Three human cadaver models were used for this feasibility study in an institutional review board (IRB) approved clinical lab. The abdominal part has been described in previous publications and can be performed with similar techniques [1,2], using either a multiport (da Vinci XI) or a single port approach with two assistant trocars (da Vinci SP).…”