Surgical robotics for esophageal cancer

Grimminger, Peter P.; Ruurda, Jelle P.; Det, Marc J. van; Morel, Philippe; Hillegersberg, Richard van

doi:10.1111/nyas.13676

Cited by 13 publications

(10 citation statements)

References 43 publications

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“…Combined with the dexterity of the articulating instruments, a very precise dissection of the esophagus is facilitated, even in difficult areas along the tissue planes of the surrounding structures. [21][22][23] These features may well improve the radical resection rate for downstaged cT4b tumors, which is pivotal in achieving good oncologic outcomes.…”

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confidence: 99%

Salvage Robot-Assisted Minimally Invasive Esophagectomy (RAMIE) for T4b Esophageal Cancer After Definitive Chemoradiotherapy

et al. 2020

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Background Patients with esophageal cancer that invades adjacent structures (cT4b) are precluded from surgery and usually treated with definitive chemoradiotherapy (dCRT). dCRT might result in sufficient downstaging to enable a radical resection, possibly improving survival. This study aimed to assess the perioperative and oncologic outcomes of a salvage robot-assisted minimally invasive esophagectomy (RAMIE) in patients with cT4b esophageal cancer after dCRT. Methods Between June 2012 and November 2019, patients who underwent a RAMIE with a gastric conduit reconstruction after completion of dCRT for cT4b esophageal carcinoma were identified from a prospectively maintained surgical database at the University Medical Center Utrecht. Results In total, 24 patients with a histopathologically confirmed T4b adenocarcinoma or squamous cell carcinoma of the esophagus were included. The adjacent organs involved were the tracheobronchial tree (67%), aorta (21%) or both (13%). No conversions or major intraoperative complications were observed. A radical resection was achieved in 22 patients (92%), and a pathologic complete response was observed in 13 (54%) patients. Postoperative grade 2 or higher complications occurred in 20 patients (83%). The disease-free survival at 24 months was 68% for the patients in whom a radical resection was achieved. Conclusion In patients with cT4b esophageal cancer treated with dCRT followed by a salvage RAMIE, a radical resection rate of 92% was achieved, with acceptable complications and promising survival rates. These results demonstrate the feasibility of a curative surgical treatment for patients with initially irresectable esophageal cancer but underscore the importance of a proper preoperative patient selection.

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confidence: 99%

Salvage Robot-Assisted Minimally Invasive Esophagectomy (RAMIE) for T4b Esophageal Cancer After Definitive Chemoradiotherapy

et al. 2020

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“…The most common techniques have narrowed to stapled versus continuous hand-sewn anastomoses, 33 but recently also included robotic-assisted anastomoses. 34 In pediatric esophageal surgery, robot-assisted esophageal surgery has only been conducted experimentally in swine. 35,36 Concerning staplers, we have previously shown that their use is currently not advisable due to size discrepancy between staplers and patient's anatomy.…”

Section: Discussionmentioning

confidence: 99%

A Continuous Suture Anastomosis Outperforms a Simple Interrupted Suture Anastomosis in Esophageal Elongation

et al. 2020

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Introduction Long-gap esophageal atresia represents a distinct entity among the esophageal atresia spectrum. In many patients, achieving a reasonable anastomosis depends on some millimeters of tissue. We aimed to determine what effect the suturing technique would have on esophageal ex vivo elongation as it may determine the strength of a primary anastomosis. Materials and Methods In an analysis of porcine esophagi from animals for slaughter (100–120 days old with a weight of 100–120 kg), we determined esophageal length gain of simple continuous and simple interrupted suture anastomoses subjected to linear traction until linear breaking strength was reached. Statistical power of 80% was ensured based on an a priori power analysis using five specimens per group in a separate exploratory experiment. Results The simple continuous suture anastomosis in 15 porcine esophagi ( = 4.47 cm, 95% confidence interval: 4.08–4.74 cm) outperformed the simple interrupted suture anastomosis in another 15 esophagi ( = 3.03 cm, 95% confidence interval: 2.59–3.43 cm) in length gain (Δ = 1.44 cm, 95% confidence interval: 0.87–2.01 cm, p < 0.0001). Conclusion Simple continuous anastomoses achieved higher length gain compared with simple interrupted suture anastomoses. This effect warrants an experimental assessment in vivo to assess its potential merits for clinical applicability.

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“…Although there are various potential technical advantages of robots over conventional thoracoscopy, Grimminger and colleagues [1] hold the view that surgical robot and thoracoscopy were both minimally invasive approaches that applied the same steps and approaches. The benefits of the robot are therefore not fully realized.…”

Section: Discussionmentioning

confidence: 99%

Robotic-assisted simultaneous resection of a left-sided thymic neoplasm and a right-sided lower thoracic paravertebral neoplasm via the same ports and two docking steps: a case report

Zhang

Wang

Zheng

et al. 2019

J Cardiothorac Surg

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BackgroundThe authors presented a 63-year old female synchronously complicated with a thymic tumor located at the left-side of the superior mediastinum, and a paravertebral tumor located at the right-side of the lower thorax. Conventional thoracoscopic surgical procedure using rigid instruments to simultaneously resect the two tumors via the same ports might be technically challenging. To our knowledge, the use of a surgical robot allowed the surgeon to perform precise dissection from extreme angles with the characteristic of articulating surgical instruments.Case presentationTwo lesions were successfully dissected using the da Vinci Surgical System through the same four ports on the right side of the chest and two-step docking. Firstly, the patient cart came from the dorsal side of the patient and the paravertebral neoplasm was dissected. Afterwards, the patient cart was undocked and the operation table was rotated 180 degrees counterclockwise. The robot was re-introduced and the patient cart came from the ventral side of the patient and the whole thymus was resected.ConclusionThis case report suggests that two-step docking via the same four ports for these two tumors located at different directions of the thorax was safe and effective, demonstrating a clear advantage of the surgical robot.

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Surgical robotics for esophageal cancer

Cited by 13 publications

References 43 publications

Salvage Robot-Assisted Minimally Invasive Esophagectomy (RAMIE) for T4b Esophageal Cancer After Definitive Chemoradiotherapy

Salvage Robot-Assisted Minimally Invasive Esophagectomy (RAMIE) for T4b Esophageal Cancer After Definitive Chemoradiotherapy

A Continuous Suture Anastomosis Outperforms a Simple Interrupted Suture Anastomosis in Esophageal Elongation

Robotic-assisted simultaneous resection of a left-sided thymic neoplasm and a right-sided lower thoracic paravertebral neoplasm via the same ports and two docking steps: a case report

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