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

Abstract

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.

Clinical outcomes of the robot-assisted Ivor Lewis procedure for adenocarcinoma of the esophagogastric junction with semi-instrument overlap intrathoracic anastomosis

“…As a possible explanation, Siewert type III AEGJ is more likely to invade the pancreas and splenic hilum, resulting in greater risks for metastasis to the abdominal LNs and inaccurate preoperative diagnoses for resectability. As compared to a previous report ( 9 ), the conversion rate in the present study was relatively high because all cases were AEGJ rather than ESCC.…”

“…For closure of the common lumen, layered sutures between the mucosal layers or muscular layers of the esophagus and stomach are recommended ( 9 ). The robot can be used for double, full-layer, continuously sutured anastomosis to simplify the procedure and this technique is easier to master.…”

“…The main difficulty with the minimally invasive IL procedure is the intrathoracic esophagogastric anastomosis (IEA), regardless of the hand-sewn approach or the use of a stapler. Owing to the convenience for intrathoracic anastomosis, the robot-assisted hand-sewn approach is usually favored for layered anastomosis ( 9 ), but full-layer anastomosis by the hand-sewn approach for AEGJ has not been reported.…”

Robot-assisted esophagectomy with robot-sewn intrathoracic anastomosis (Ivor Lewis): surgical technique and early results

“…None of those occurred immediately after surgery meaning that it was not a late sequela of apparent or inapparent anastomotic leakage. However, this data is higher than that reported in four similar robotic series [ 10 , 11 , 15 , 16 ] although comparison of these results is difficult because of the heterogeneity in surgical techniques. In addition, our result is slightly higher than the stricture rates reaching 18% reported in a meta-analysis of MI ILE including both end-to-end and side-to-side techniques [ 35 ].…”