International consensus statement on robot-assisted minimally invasive esophagectomy (RAMIE)

Li, Bin; Yang, Yang; Toker, Alper; Yu, Bentong; Kang, Chang Hyun; Abbas, Ghulam; Soukiasian, Harmik J.; Li, Hecheng; Daiko, Hiroyuki; Jiang, Hongjing; Fu, Jianhua; Yi, Jun; Kernstine, Kemp H.; Bouvet, Michael; Ricciardi, Sara; Chao, Yin‐Kai; Kim, Yong Hee; Wang, Yun; Yu, Zhentao; Abbas, Abbas E.; Sarkaria, Inderpal S.; Li, Zhigang

doi:10.21037/jtd-20-1945

Cited by 18 publications

(15 citation statements)

References 84 publications

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“…Minimally invasive and open esophagectomy show comparable oncological outcomes and survival [1,2], but with the thoracoscopic approach, significant advantages in terms of post-operative pain, short in-hospital stay, recovery time, and morbidity, particularly regarding pulmonary infections, are reported [1,2,10]. However, in spite of these advantages, its widespread use is still limited mainly because of the technical challenges of the reconstructive phase, which can lead to high risk of fistula and therefore failure of the entire operation.…”

Section: Discussionmentioning

confidence: 99%

“…thoracoscopic phases, has been introduced to overcome the frequent complications that generally occur after thoracotomy, above all, pulmonary infections. Moreover, MIILE provides some other advantages over the open approach, such as fast recovery, less postoperative pain, and shorter in-hospital stays without compromising oncological results [1,2]. However, in addition to requiring advanced technical skills, the thoracoscopic approach makes it hard to perform esophagogastric anastomosis safely, as the reported rates of anastomotic leak vary from 5 to 16% in the best of cases, depending on the surgeon's experience and the technique adopted.…”

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confidence: 99%

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Technical details for a robot-assisted hand-sewn esophago-gastric anastomosis during minimally invasive Ivor Lewis esophagectomy

et al. 2021

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Background Minimally invasive Ivor Lewis esophagectomy (MIILE) provides better outcomes than open techniques, particularly in terms of post-operative recovery and pulmonary complications. However, in addition to requiring advanced technical skills, thoracoscopic access makes it hard to perform esophagogastric anastomosis safely, and the reported rates of anastomotic leak vary from 5 to 16%. Several minimally invasive esophago-gastric anastomotic techniques have been described, but to date strong evidence to support one technique over the others is still lacking. We herein report the technical details and preliminary results of a new robot-assisted hand-sewn esophago-gastric anastomosis technique. Methods From January 2018 to December 2020, 12 cases of laparoscopic/thoracoscopic Ivor Lewis esophagectomy with robot-assisted hand-sewn esophago-gastric anastomosis were performed. The gastric conduit was prepared and tailored taking care of vascularization with a complete resection of the gastric fundus. The anastomosis consisted of a robot-assisted, hand-sewn four layers of absorbable monofilament running barbed suture (V-lock). The posterior outer layer incorporated the gastric and esophageal staple lines. Results The post-operative course was uneventful in nine cases. Two patients developed chyloperitoneum, one patient a Sars-Cov-2 infection, and one patient a late anastomotic stricture. In all cases, there were no anastomotic leaks or delayed gastric conduit emptying. The median post-operative stay was 13 days (min 7, max 37 days); the longest in-hospital stay was recorded in patients who developed chyloperitoneum. Conclusion Despite the small series, we believe that our technique looks to be promising, safe, and reproducible. Some key points may be useful to guarantee a low complications rate after MIILE, particularly regarding anastomotic leaks and delayed emptying: the resection of the gastric fundus, the use of robot assistance, the incorporation of the staple lines in the posterior aspect of the anastomosis, and the use of barbed suture. Further cases are needed to validate the preliminary, but very encouraging, results.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Technical details for a robot-assisted hand-sewn esophago-gastric anastomosis during minimally invasive Ivor Lewis esophagectomy

et al. 2021

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“…Pretreatment-assisted robot intrathoracic layered anastomosis: our exploration in Ivor-Lewis esophagectomy Ivor-Lewis esophagectomy with intrathoracic EGA (8).…”

Section: Original Articlementioning

confidence: 99%

Pretreatment-assisted robot intrathoracic layered anastomosis: our exploration in Ivor-Lewis esophagectomy

Xu¹,

Zhuo²,

Song³

et al. 2021

J Thorac Dis

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Background: Minimal invasive Ivor-Lewis esophagectomy (MIIVE) with intrathoracic esophago-gastric anastomosis (EGA) is still under exploration and the preferred technique for intrathoracic anastomosis has not been established. Methods: We retrospectively reviewed 43 consecutive patients who underwent MIIVE using the series technique called pretreatment-assisted robot intrathoracic layered anastomosis (PRILA), performed by a single surgeon between September 2018 and December 2020. The operative outcomes were analyzed. Results: The mean total operation time had been reduced from 446.38±54.775 minutes (range, 354-552) in the first year to 347.70±60.420 minutes (range, 249-450) later. There were no conversions to thoracotomy. All the patients achieved R0 resection. No patient suffered from anastomotic leakage. There was no 30-day mortality. The median length of postoperative stay was 10.0 days. Conclusions: PRILA further visualizes and streamlines the process of minimal invasive intrathoracic EGA, thus ensuring the precise anastomosis. It could be considered as a feasible alternative for intrathoracic EGA in MIILE.

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“…The robotic thoracic approach is in full development, with clear indications for resection in lung cancer (37) , and even the esophageal approach has been internationally agreed upon (38) . In 2020, Durand et al (39) published the first study of robotic lobectomy in seven pediatric patients.…”

Section: Discussionmentioning

confidence: 99%

Implementing a pediatric robotic surgery program: future perspectives

Beauregard¹,

García²,

Amillo³

et al. 2022

Cir Pediatr

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The minimally invasive approach using robotic technology is fully incorporated in the treatment of adult pathologies.The first international pediatric studies with a robotic approach date from 2002, and in Spain, from 2009. We present the implementation of a Pediatric Robotic Surgery program in our setting. Materials and methods.A proposal for the application of robotic technology in pediatrics was developed, and after the acquisition of a Da Vinci Xi system at our center, a program was initiated under the guidance of a pediatric surgeon experienced in this approach.Results. 32 patients with a median age of 12 years (7 months-17 years) have been operated on since January 2019. 56% of the procedures were abdominal. 3 thoracic approaches and 11 urologic procedures were carried out. 1 conversion to open surgery was performed during a fundoplication. The median combined duration of abdominal and thoracic approaches was 155 minutes (70-380 minutes). There were no anesthetic or hemodynamic complications. The postoperative period in the cases in which the procedure was completed was uneventful, and patients were discharged after a median of 2 days (1-16 days). Conclusion.The main advantage of robotic procedures is the symmetrical movement in line with the surgeon's hands, which makes the learning curve shorter. In our experience, the robotic approach has allowed for greater precision in the surgical technique, favoring the patient's recovery.

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International consensus statement on robot-assisted minimally invasive esophagectomy (RAMIE)

Cited by 18 publications

References 84 publications

Technical details for a robot-assisted hand-sewn esophago-gastric anastomosis during minimally invasive Ivor Lewis esophagectomy

Technical details for a robot-assisted hand-sewn esophago-gastric anastomosis during minimally invasive Ivor Lewis esophagectomy

Pretreatment-assisted robot intrathoracic layered anastomosis: our exploration in Ivor-Lewis esophagectomy

Implementing a pediatric robotic surgery program: future perspectives

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