Robotic technological aids in esophageal surgery

Abstract

Robotic technology is an emerging technology that has been developed in order to overcome some limitations of the standard laparoscopic approach, offering a stereoscopic three-dimensional visualization of the surgical field, increased maneuverability of the surgical tools with consequent increased movement accuracy and precision and improved ergonomics. It has been used for the surgical treatment of most benign esophageal disorders. More recently, it has been proposed also for patients with operable esophageal cancer. The current evidence shows that there are no real benefits of the robotic technology over conventional laparoscopy in patients undergoing a fundoplication for gastroesophageal reflux disease (GERD), hiatal closure for giant hiatal hernia, or Heller myotomy for achalasia. A few small studies suggest potential advantages in patients undergoing redo surgery for failed fundoplication or Heller myotomy, but large comparative studies are needed to better clarify the role of the robotic technology in these patients.Robot-assisted esophagectomy seems to be safe and effective in selected patients; however, there are no data showing superiority of this approach over both conventional laparoscopic and open surgery. The short-term and long-term oncologic results of ongoing randomized controlled trials (RCTs) are awaited to validate this approach for the treatment of esophageal cancer.

Robotic-Assisted Laparoscopic Redo Nissen Fundoplication. Does it Offer Advantages in Children?

“…The need for a revision surgery after a fundoplication is a very variable event and, fundamentally, it is considered that it depends on the experience of the surgeon and the volume of surgeries depending on the center where he works, and the volume of cases (experience) per surgeon [14]. The results of published series of patients with redo, open or laparoscopic fundoplication show that the index of failure of this, is greater than in primary surgery [29,31,62,69].…”

“…There is a scarcity of publications from Latin American countries to date that describe pediatric patients who have undergone robotic surgery [13,56,57], and in relation to the number of RALRNF publications in the world, it is also limited, including the adult and pediatric population [20,[58][59][60][61][62]. Objective of this study is to present our experience in RALRNF and highlight its advantages in children.…”

Robotic Approach in Benign and Malignant Esophageal Tumors; A Preliminary Seven Case Series

“…We consider that the stable 3-dimensional view of the surgical field along with articulated surgical tools might help reach the upper mediastinum with better ergonomics, and allow a wide and precise dissection of the esophagus and periesophageal tissues and the mediastinal structures thus leading, as the Dutch group have speculated, to a higher number of lymph node harvested and possibly to higher rates of radicality in patients with large tumor providing good local control with a low percentage of local recurrence at long-term follow up (4,12). Dissection of a large esophageal leiomyoma from the subjacent mucosa is easier and safer performed using the robotic approach, suturing and dexterity skills are performed quicker than does manual thoracoscopy or laparoscopy (13).…”

Laparoscopic fundoplication assisted by robot

“…When laparoscopic approach versus assisted by robot are contrasted, most published series agree that robotic surgery usually consumes more surgical time, with total times of 86 to 173 min for conventional laparoscopic, and 137 to 222 for robitic surgery, being maybe due to the time of docking, which has been reported from 5.3 to 23 minutes [6,[13][14][15][16][17][18]. However, this result has been inconstant on the experience of different authors, as the meta-analyzes of Yao et al [19] and Cundy 3 surgeons participated in the performance of the surgeries.…”

“…On the other hand, the average hospital stay is similar regardless of the approach, but widely variable depending on the author's preferences, with a range of 18 hrs (0.75 days) to 105.6 hrs (4.4 days) [12][13][14][15][17][18][19][20][21]23]. In the present series, the average hospital stay was 39.4hrs (1.6 days), with a stay in census beds of one night in 89% of cases.…”