Minimally Invasive and Robotic Esophagectomy

2021 ◽  
pp. 1-4
Author(s):  
Haydee de Calvo ◽  
Min P. Kim
Keyword(s):  
Minimally Invasive ◽  
Robotic Esophagectomy

PS01.232: SHORT-TERM OUTCOMES OF ROBOT-ASSISTED MINIMALLY INVASIVE ESOPHAGECTOMY

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 115-116
Author(s):  
Haiqi He ◽  
Junke Fu ◽  
Guangjian Zhang
Keyword(s):  
Minimally Invasive ◽  
Conflicts Of Interest ◽  
Minimally Invasive Esophagectomy ◽  
Pulmonary Complications ◽  
Invasive Technique ◽  
R0 Resection ◽  
Robot Assisted ◽  
Invasive Esophagectomy ◽  
Robotic Esophagectomy ◽  
Laparoscopic Esophagectomy

Abstract Background Surgical resection with radical lymphadenectomy is a pivotal component in the multidisciplinary therapy of esophageal cancer. Minimally invasive esophagectomy was shown to be effective in reducing the morbidity and was adopted increasingly. As a novel minimally invasive technique, robot-assisted esophagectomy remains in the initial stage ofapplication. This study describes the single-institution experience of robotic esophagectomy. Methods Between March 2016 and October 2017, 20 consecutive patients underwent robot assisted esophagectomy at our institute. The thoracic and abdominal mobilization were all performed with the assistance of the robot. We retrospectively collected the operative data and postoperative outcomes. Results The majority of patients were male (80%), and the median age was 62 years. The average operative time was 342 minutes (range 280–440). The average blood loss was 112 ml (range 50–400). No patient experienced conversion to a thoracotomy or laparotomy. R0 resection was achieved in all patients, the mean number of dissected lymph nodes was 19 (range 8–32). No 90-day operative mortality was observed, and postoperative complications were present in 8 of 20 patients (40.0%). Pulmonary complications were the most common event and were observed in 3 patients. Two patients experienced an anastomotic leak. Conclusion Our study demonstrated that robot-assisted esophagectomy is a safe and technically feasible alternative to conventional thoraco-laparoscopic esophagectomy. Disclosure All authors have declared no conflicts of interest.

Redefining the learning curve for robotic esophagectomy.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 132-132
Author(s):  
Ken Lee Meredith ◽  
Jamie Huston ◽  
Pedro Briceno ◽  
Ravi Shridhar
Keyword(s):  
Minimally Invasive ◽  
Learning Curve ◽  
Minimally Invasive Esophagectomy ◽  
Neoadjuvant Chemoradiation ◽  
Esophageal Disease ◽  
Robotic Assisted ◽  
Invasive Esophagectomy ◽  
Robotic Esophagectomy ◽  
Conversion Rates ◽  
Morbidity Index

132 Background: Minimally invasive esophagectomy(MIE) has demonstrated superior outcomes compared to open approaches. The myriad of techniques has precluded the recommendation of a standard approach. The robotic approach has increased steadily. We have previously published our series defining the learning curve for this approach. The purpose of this study is to redefine the learning curve for robotic-assisted esophagogastrectomy with respect to operative time, conversion rates, and patient safety. Methods: We have prospectively followed all patients undergoing robotic-assisted esophagogastrectomy and compared operations performed at our institutions by a single surgeon in successive cohorts. Our measures of proficiency included: operative times, conversion rates, and complications. Statistical analyses were undertaken utilizing Spearman regression analysis and Mann-Whitney U test. Significance was accepted with 95 % confidence. Results: We identified 203 patients (166 [81.8%] male: 37 [18.2%] female) of median age of 67.2 (30-90) years who underwent robotic-assisted esophagogastrectomies for malignant esophageal disease. One-hundred sixty six were adenocarcinoma, 26 were squamous cell carcinoma and 11 were other. R0 resections was performed in 202 (99.5%) of patients. The median lymph node harvest was 18 (6-63). Neoadjuvant chemoradiation was administered to 157 (77.4%) patients. A significant reduction in operative times (p <0.005) following completion of 20 procedures was identified (514 ± 106 min vs. 415± 91 min compared to subsequent 80 cases and further reduced with the subsequent 100 cases 397 ± 71.9 min) p<0.001. Complications decreased after the initial learning curve of 29 cases, p=0.04. However there was an increase in complications after 90 cases in which there was an increase in the Charleson morbidity index, p<0.01 indicating higher risk patients which tapered after case 115. Conclusions: For surgeons proficient in performing minimally-invasive esophagogastrectomies, the learning curve for a robotic-assisted procedure appears to begin near proficiency after 20 cases however as more complex cases are undertake there appears to be an additional learning curve which is surpassed after 90 cases.

Minimally invasive and robotic esophagectomy: Evolution and evidence

2016 ◽  
Vol 114 (6) ◽  
pp. 731-735 ◽  
Author(s):  
Yassar A. Qureshi ◽  
Khaled I. Dawas ◽  
Muntzer Mughal ◽  
Borzoueh Mohammadi
Keyword(s):  
Minimally Invasive ◽  
Robotic Esophagectomy

Change from Hybrid to Fully Minimally Invasive and Robotic Esophagectomy is Possible without Compromises

2018 ◽  
Vol 67 (07) ◽  
pp. 589-596 ◽  
Author(s):  
P. P. Grimminger ◽  
E. Tagkalos ◽  
E. Hadzijusufovic ◽  
F. Corvinus ◽  
B. Babic ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Esophageal Carcinoma ◽  
Circular Stapler ◽  
Esophageal Resection ◽  
Western World ◽  
Wound Infections ◽  
Term Outcome ◽  
Hybrid Approaches ◽  
Robotic Esophagectomy ◽  
Hybrid Group

Background The incidence of esophageal carcinoma is increasing in the western world, and esophageal resection is the essential therapy. Several studies report advantages of minimally invasive esophagectomies (MIEs) versus conventional open procedures (OPs). The benefits of the use of fully MIE or robot-assisted MIE (RAMIE) compared with the hybrid approaches (laparoscopic gastric preparation and open transthoracic esophagectomy) remain unclear. Methods Between July 2015 and August 2017, the data of 75 patients with esophageal carcinoma were prospectively registered. Of the 75 patients, 25 treated with a hybrid MIE (hybrid), 25 with total MIE (MIE), and 25 with RAMIE. All patients were operated by the same specialized surgeon in our center with an identical anastomotic technique (circular stapler). Results The overall 30- and 90-day mortality rates were 0 and 1.33% (1/75), respectively. Total hospital stay (p = 0.262), intensive care unit stay (p = 0.079), number of resected lymph nodes (p = 0.863), and R status (p = 0.132) did not differ statistically between the groups. However, pneumonia and wound infections occurred significantly and more frequently in the hybrid group compared with the minimally invasive groups (MIE and RAMIE) (p = 0.046 and p = 0.003, respectively). Conclusion Comparable results regarding morbidity and short-term outcome could be achieved in the MIE and RAMIE groups compared with the hybrid group. The data indicate that the learning curve is low in surgeons changing the technique form hybrid esophagectomy to fully MIE. Additionally, the total minimally invasive approaches seem to be associated with a low incidence of complications such as pneumonia and wound infections.

Minimally Invasive and Robotic Esophagectomy

2018 ◽  
Vol 13 (6) ◽  
pp. 391-403 ◽  
Author(s):  
Raghav A. Murthy ◽  
Nicholas S. Clarke ◽  
Kemp H. Kernstine
Keyword(s):  
Minimally Invasive ◽  
Minimally Invasive Esophagectomy ◽  
Surgical Techniques ◽  
Esophageal Resection ◽  
Esophageal Disease ◽  
High Morbidity ◽  
Invasive Esophagectomy ◽  
Transhiatal Approach ◽  
Minimally Invasive Surgical ◽  
Robotic Esophagectomy

Great advances have been made in the surgical management of esophageal disease since the first description of esophageal resection in 1913. We are in the era of minimally invasive esophagectomy. The current three main approaches to an esophagectomy are the Ivor Lewis technique, McKeown technique, and the transhiatal approach to esophagectomy. These operations were associated with a high morbidity and mortality. The recent advances in minimally invasive surgical techniques have greatly improved the outcomes of these surgical procedures. This article reviews the literature and describes the various techniques available for performing minimally invasive esophagectomy and robot-assisted esophagectomies, the history behind the development of these techniques, the variations, and the contemporary outcomes after such procedures.

scholarly journals Robotic resection for esophageal cancer

2020 ◽  
Author(s):  
Jan-Niclas Kersebaum ◽  
Thorben Möller ◽  
Thomas Becker ◽  
Jan-Hendrik Egberts
Keyword(s):  
Quality Of Life ◽  
Esophageal Cancer ◽  
Minimally Invasive ◽  
Minimally Invasive Esophagectomy ◽  
Tumor Resection ◽  
Oncologic Outcomes ◽  
Term Survival ◽  
Invasive Esophagectomy ◽  
Robotic Esophagectomy

Summary Background In the surgical treatment of esophageal cancer, complete tumor resection is the most important factor and determines long-term survival. With an increase in robotic expertise in other fields of surgery, robotic-assisted minimally invasive esophagectomy (RAMIE) was born. Currently, there is a lack of convincing data on the extent of expected benefits (perioperative and oncologic outcomes and/or quality of life). Some evidence exists that patients’ overall quality of life and physical function improves, with less fatigue and pain 3 months after surgery. We aimed to review the available literature regarding robotic esophagectomy, compare perioperative, oncologic, and quality of life outcomes with open and minimally invasive approaches, and give a brief overview of our standardized four-arm RAMIE technique and explore future directions. Methods A Medline (PubMed) search was conducted including the following key words: esophagectomy, minimally invasive esophagectomy, robotic esophagectomy, Ivor Lewis and McKeown. We present the history, different techniques used, outcomes, and the standardization of robotic esophagectomy. Results Robotic esophagectomy offers a steeper learning curve with fewer complications but comparable oncological results compared to conventional minimally invasive esophagectomy. Conclusions Available studies suggest that RAMIE is associated with benefits regarding length of stay, clinical outcomes, and quality of life—if patients are treated in an experienced center with a standardized technique for robotic esophagectomy—making it a potentially beneficial tool in the treatment of esophageal cancer. However, center-wide standardization and prospective data collection will be a necessity to prove superiority of robotic esophagectomy.

scholarly journals Specific complications and limitations of robotic esophagectomy

2020 ◽  
Vol 33 (Supplement_2) ◽  
Author(s):  
Abbas E Abbas ◽  
Inderpal S Sarkaria
Keyword(s):  
Minimally Invasive ◽  
Minimally Invasive Esophagectomy ◽  
Significant Risk ◽  
Vocal Cord Palsy ◽  
Robotic Platform ◽  
Invasive Esophagectomy ◽  
Robotic Esophagectomy ◽  
Short And Long Term ◽  
Careful Assessment

SUMMARY Regardless of the approach to esophagectomy, it is an operation that may be associated with significant risk to the patient. Robotic-assisted minimally invasive esophagectomy (RAMIE) has the same potential for short- and long-term complications as does open and minimally invasive esophagectomy. These complications include among others, the risk for anastomotic leak, gastric tip necrosis, vocal cord palsy, and chylothorax. Moreover, there are additional risks that are unique to the robotic platform such as hardware or software malfunction. These risks are heavily influenced by numerous factors including the patient’s comorbidities, whether neoadjuvant therapy was administered, and the extent of the surgical team’s experience. The limitations of RAMIE are therefore based on the careful assessment of the patient for operability, the tumor for resectability and the team for surgical ability. This article will tackle the topic of complications and limitations of RAMIE by examining each of these issues. It will also describe the recommended terminology for reporting post-esophagectomy complications.

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