How I do it: robotic-assisted Ivor Lewis esophagectomy

Abstract

SUMMARY Advances in minimally invasive techniques, including robotic surgical technology, have led to improved outcomes in esophagectomy. In this article, we detail our approach to the robotic Ivor Lewis esophagectomy.

Robot-assisted Ivor Lewis Esophagectomy (RAILE): A review of surgical techniques and clinical outcomes

“…In most high-volume centers, RAILE is performed with a da Vinci Surgical System (Intuitive Surgical, Inc., Sunnyvale, CA) and a four-arm technique. As many publications reported experience and details of different parts of RAILE (8)(9)(10)(11)(12)(13), we generally summarize the well-accepted procedure. We propose several possible ways for the same step and the literature in which they are described in detail if they are currently performed with no significant increase in adverse events.…”

“…At this point, the stomach has been completely mobilized (10). The abdominal portion can also begin with the greater curvature of the stomach and mobilize the stomach towards the crus of the diaphragm if preferred (12).…”

“…There are three major methods used for reconstruction as described in the following paragraphs and Figure 3. The anastomosis can be finally reinforced with an omental wrap to prevent leakage (9,12). Circular stapled anastomosis: This is the most commonly used anastomosis technique in RAILE because of its relative reliability and simplicity.…”

“…After appropriately marrying the spike and anvil, the anastomosis is formed by firing. Finally, the proximal redundant conduit and gastrotomy are closed with an endostapler (12,19).…”