Robotic esophagectomy

Abstract

esophagectomy should be considered. If EMR is performed in the context of Barrett's esophagus, radiofrequency ablation (RFA) to promote regression of the Barrett's should also be considered. Patients with persistent high-grade dysplasia after attempted RFA should also be considered for esophagectomy. EquipmentThe Da Vinci Surgical System is currently the only FDAapproved robotic system for lung surgery. The surgeon sits at a console some distance from the patient who is positioned on an operating table in close proximity to the robotic unit with its four robotic arms. The robotic arms incorporate remote center technology, in which a fixed point in space is defined, and about it the surgical arms move so as to minimize stress on the thoracic or abdominal wall during manipulations. The small proprietary Endowrist instruments attached to the arms are capable of a wide range of high-precision movements. These are controlled by the surgeon's hand movements, via 'master' instruments at the console. The 'master' instruments sense the surgeon's hand movements and translate them electronically into scaled-down micro-movements to manipulate the small surgical instruments. Hand tremor is filtered out by a 6-Hz motion filter. The surgeon observes the operating field through console binoculars. The image comes from a manoeuvrable high-definition stereoscopic camera (endoscope) attached to one of the robot arms. The console also has foot pedals that allow the surgeon to engage and disengage different instrument arms, reposition the console 'master' controls without the instruments themselves moving, and activate electric cautery. A second optional console allows tandem surgery and training. Da Vinci currently offers both the Xi and Si systems. The Xi system is newer and features an overhead beam that permits rotation of the instrument arms, allowing for greater flexibility in terms of direction of approach of the robot to the patient. Compared to the Si, he Xi also has thinner instrument arms, longer instruments themselves, and the option to switch the camera to any arm/port. Preoperative evaluationThe preoperative evaluation is no different for robotic esophagectomy than for open or other forms of MIE. A history and physical exam focused on elements such as gastroesophageal reflux disease, Barrett's esophagus, achalasia and other motility disorders, prior surgeries, cardiac and pulmonary comorbidities, and functional status. Esophagoscopy should be performed to obtain the tissue diagnosis, rule out a synchronous secondary primary, as well as document location of tumor and presence of associated findings such as Barrett's esophagus. Bronchoscopy is necessary in all proximal and middle-third tumors to evaluate local airway invasion or a synchronous second primary. Endoscopic ultrasound locally stages the tumor by evaluating the depth of penetration and involvement of regional lymph nodes, also offering fine-needle aspiration biopsy of suspicious lymph nodes if necessary. PET-CT of the chest, abdomen, and pelvis fulfills the st...

Robotic/thoracoscopic approach to esophageal gastro-intestinal stromal tumor

“…The robotic approach to esophagectomy has been described by several authors (24,25), and was the object of a recent large review by Harbison et al comparing outcomes of robotic assisted versus non-robotic minimally invasive esophagectomy for esophageal cancer using the NSQIP database. They found robotic esophagectomy to be feasible on a larger scale with outcome similar to the standard of care regarding adequacy of the oncologic resection and complications (26).…”

Minimally invasive esophagectomy

“…Therefore, he changed the technique from hand sewn to stapled anastomosis. Moreover, patient selection was modified in terms of nutritional status, cardiopulmonary performance and risk factors related with liver disease [86,87].…”

Minimally invasive and robotic esophagectomy: state of the art

“…At multivariate analysis, preoperative concurrent chemoradiation was a risk factor for pulmonary complications. In extensive mediastinal lymphadenectomy, Broussard et al (38) Causes for these high rates were identified in anastomotic complications and wrong selection of patients. Therefore, corrective actions were taken.…”