THE Big Deal: An Institution's Experience with Robotic Transhiatal Esophagectomy

Abstract

As minimally invasive operations evolve, it is imperative to evaluate the advantages and risks involved. The aim of our study was to evaluate our institution's experience in incorporating a robotic platform for transhiatal esophagectomy (THE). Patients undergoing robotic THE were prospectively followed. Data are presented as median (mean ± SD). Forty-five patients were of 67 (67 ± 6.9) years and BMI 26 (27 ± 5.5) kg/m2. Nine per cent of operations were converted to “open,” but none in the last 25 operations. Operative duration of robotic THE was 334 (364 ± 108.8) minutes and estimated blood loss was 200 (217 ± 144.0) mL, which decreased with time ( P = 0.017). Length of stay was 8 (12 ± 11.1) days. Twenty per cent had respiratory failure requiring intubation that resolved, 4 per cent developed pneumonia, 11 per cent developed a surgical site infection, 2 per cent developed renal insufficiency, and 2 per cent developed a UTI. Two per cent (one patient) died within 30 days postoperatively, because of cardiac arrest. Our experience with robotic THE promotes robotic application because we endeavor to achieve high-level proficiency. With experience, we improved estimated blood loss and converted fewer transhiatal esophagectomies to “open.” Our length of hospital stay seems long but reflects the ill-health of patients, as does the variety of complications. Our data support the evolving future of THE, which will integrally include a robotic approach.

Robotic esophagectomy: the evolution of open esophagectomy to current techniques and a review of the literature

“…One patient died within 30 days secondary to cardiac arrest. The conversion rate was 9%, however none were converted in the last 25 operations and blood loss also decreased over time from an initial average of 200 cc [88] .…”

“…Others have also reported similar outcomes [84][85][86][87] . More recently, Wecowski et al [88] prospectively reported their experience in incorporating a robotic platform for transhiatal esophagectomy. Operative duration was 334 (364 ± 108.8) min, and length of stay was 8 days.…”

“…Operative duration was 334 (364 ± 108.8) min, and length of stay was 8 days. Morbidity rates were also fairly high and included respiratory failure requiring intubation (20%), pneumonia (4%), surgical site infection (11%), renal insufficiency (2%), and UTI (2%) [88] . One patient died within 30 days secondary to cardiac arrest.…”

Evaluating the Cost for Robotic vs “Non-Robotic” Transhiatal Esophagectomy

“…The treatment of esophageal cancer has evolved similarly for both neoadjuvant and adjuvant therapy; who gets it, for how long, and what does it constitute remain questions at the core of adjunctive nonoperative therapy (ie, radiation and chemotherapy). [4][5][6] The most recent perceived, yet unproven, advancement in esophagectomy is the application of minimally invasive esophagectomy, generally utilizing the robotic platform as a robotic transhiatal esophagectomy (THE). Robotic THE may potentially reduce post-operative complications and length of stay compared to the traditional "open" esophagectomy, without compromising oncological control.…”

“…Robotic THE may potentially reduce post-operative complications and length of stay compared to the traditional "open" esophagectomy, without compromising oncological control. 5,[7][8][9] Transhiatal esophagectomy and Ivor-Lewis thoraco-abdominal esophagectomy carry a high rate of post-operative morbidity and mortality, allowing tremendous room for improvement. 10 With annual health care costs rising to four trillion dollars in the United States during the last year, there is a constant need for reducing health care costs of major abdominal and thoracic operations and utilizing the robotic platform may assist in this.…”