Technical details for a robot-assisted hand-sewn esophago-gastric anastomosis during minimally invasive Ivor Lewis esophagectomy

Background: Intrathoracic esophagogastrostomy plays an important role in minimally invasive Ivor-Lewis esophagectomy for cancer. Intrathoracic anastomosis with robot-assisted Ivor-Lewis esophagectomy (RAILE) includes hand-sewn and circular stapler methods, which remain technically challenging. In this study, we modified the techniques for intrathoracic anastomosis at RAILE, in order to simplify the complex procedures. Methods: “Side-insertion” technique was used for anvil placement and purse string suture for intrathoracic anastomosis at RAILE. Medical records for consecutive patients who had undergone robot-assisted minimally invasive Ivor-Lewis esophagectomy for cancer between January 2015 and June 2018 were analyzed. Results: A total of consecutive 31 patients were enrolled. There was no conversion to open thoracotomy in this cohort. Mean operation duration in the robotic group was 387.4 ± 68.2 min. Median estimated blood loss was 110 mL (range 50–400 mL). Two patients (6.5%) had postoperative anastomotic leak. No postoperative reoperation was needed and there were no mortality. Six patients (19.4%) had anastomotic stricture and 2 patients of them needed endoscopic dilation. Conclusion: RAILE is safe and feasible. Our modified procedure highlighting the “side-insertion” method may simplify the process of intrathoracic anvil placement and purse string suture for anastomosis at RAILE.

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Robot-Assisted Minimally Invasive Ivor Lewis Esophagectomy With Real-Time Perfusion Assessment

The Annals of Thoracic Surgery ◽

10.1016/j.athoracsur.2015.03.084 ◽

2015 ◽

Vol 100 (3) ◽

pp. 947-952 ◽

Cited By ~ 25

Author(s):

Arielle Hodari ◽

Ko Un Park ◽

Brian Lace ◽

Athanasios Tsiouris ◽

Zane Hammoud

Keyword(s):

Minimally Invasive ◽

Real Time ◽

Robot Assisted ◽

Ivor Lewis ◽

Ivor Lewis Esophagectomy ◽

Perfusion Assessment

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Minimally invasive Ivor Lewis esophagectomy: Robot-assisted versus laparoscopic–thoracoscopic technique. Systematic review and meta-analysis

Surgery ◽

10.1016/j.surg.2021.07.013 ◽

2021 ◽

Author(s):

Cristian A. Angeramo ◽

Camila Bras Harriott ◽

María A. Casas ◽

Francisco Schlottmann

Keyword(s):

Systematic Review ◽

Minimally Invasive ◽

Meta Analysis ◽

Robot Assisted ◽

Ivor Lewis ◽

Ivor Lewis Esophagectomy ◽

Thoracoscopic Technique

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Robot-assisted esophagogastric reconstruction in minimally invasive Ivor Lewis esophagectomy

Journal of Thoracic Disease ◽

10.21037/jtd.2019.05.29 ◽

2019 ◽

Vol 11 (5) ◽

pp. 1860-1866 ◽

Cited By ~ 2

Author(s):

Zihao Wang ◽

Hanlu Zhang ◽

Fuqiang Wang ◽

Yun Wang

Keyword(s):

Minimally Invasive ◽

Robot Assisted ◽

Ivor Lewis ◽

Ivor Lewis Esophagectomy

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PS01.224: MODIFIED INTRATHORACIC ESOPHAGOGASTROSTOMY AT MINIMALLY INVASIVE ROBOT-ASSISTED IVOR-LEWIS ESOPHAGECTOMY FOR CANCER

Diseases of the Esophagus ◽

10.1093/dote/doy089.ps01.224 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 113-114

Author(s):

Wen-Ping Wang ◽

Long-Qi Chen ◽

Han-Lu Zhang ◽

Yu-Shang Yang ◽

Song-Lin He ◽

...

Keyword(s):

Blood Loss ◽

Minimally Invasive ◽

Esophagogastric Anastomosis ◽

Purse String Suture ◽

Robotic Group ◽

Robot Assisted ◽

Purse String ◽

Ivor Lewis ◽

Ivor Lewis Esophagectomy ◽

Esophagectomy For Cancer

Abstract Background The intrathoracic esophagogastrostomy played important role in minimally invasive Ivor-Lewis esophagectomy for cancer. The methods of intrathoracic esophagogastric anastomosis at robot-assisted Ivor-Lewis esophagectomy mostly included hand-sewn, and circular stapler (anvil placement via OrVil system or transthoracically), which were still technically challenging. In this study, we modified the techniques of intrathoracic esophagogastric anastomosis at robot-assisted Ivor-Lewis esophagectomy for cancer, in order to seek to simplify this complicated intrathoracic procedure. Then retrospective comparison between robotic and thoracoscopic cohorts was conducted. Methods We modified techniques focused on the ‘side-insertion’ anvil placement and purse string suture of intrathoracic robot-assisted esophagogastric anastomosis. The consecutive records of patients who underwent minimally invasive Ivor-Lewis esophagectomy for cancer via robot-assistant and thoracoscopic procedures in our department between January 2015 and November 2017 were retrospectively analyzed. Results Totally 47 patients were enrolled including 20 patients (male: 17, female: 3) in robot-assisted group and 27 patients (male: 21, female: 6) in thoracoscopic group. There was no conversion to open thoracotomy in both two groups. Mean operation duration of robotic group was 412.5 ± 63.5 min, significantly higher than 363.0 ± 53.3 min in thoracoscopic group (P = 0.006). Estimated blood loss in robotic group was less than that in thoracoscopic group (107.5 ± 63.5ml vs. 188.9 ± 94.3ml, respectively, P = 0.002). One patient (5.0%) in robotic group and two patients(7.4%) in thoracoscopic group had anastomotic leak. No postoperative reoperation or mortality (in-hospital or within 30 days after surgery) occurred in both groups. Conclusion Robot-assisted Ivor-Lewis esophagectomy was safe and feasible. Our modified procedure highlighting the ‘side-insertion’ method could simplify the process of intrathoracic anvil placement and purse string suture for the robot-assisted esophagogastric anastomosis. Robot-assisted Ivor-Lewis esophagectomy was nearly equivalent to thoracoscopic Ivor-Lewis esophagectomy at short-term outcomes, except higher operation time and less blood loss. Disclosure All authors have declared no conflicts of interest.

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Indocyanine green perfusion assessment of the gastric conduit in minimally invasive Ivor Lewis esophagectomy

Surgical Endoscopy ◽

10.1007/s00464-021-08346-9 ◽

2021 ◽

Author(s):

Keouna Pather ◽

Adeline M. Deladisma ◽

Christina Guerrier ◽

Isaac R. Kriley ◽

Ziad T. Awad

Keyword(s):

Minimally Invasive ◽

Indocyanine Green ◽

Gastric Conduit ◽

Ivor Lewis ◽

Ivor Lewis Esophagectomy ◽

Perfusion Assessment

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792 OUTCOMES AFTER TOTALLY MINIMALLY INVASIVE VERSUS HYBRID OR OPEN IVOR LEWIS ESOPHAGECTOMY: RESULTS FROM THE INTERNATIONAL ESODATA STUDY GROUP.

Diseases of the Esophagus ◽

10.1093/dote/doab052.792 ◽

2021 ◽

Vol 34 (Supplement_1) ◽

Author(s):

Berend Van Der Wilk ◽

Eliza R C Hagens ◽

Ben M Eyck ◽

Suzanne S Gisbertz ◽

Richard Hillegersberg ◽

...

Keyword(s):

Length Of Stay ◽

Minimally Invasive ◽

Anastomotic Leakage ◽

Hospital Length Of Stay ◽

Mortality Data ◽

Study Group ◽

Ivor Lewis ◽

Open Esophagectomy ◽

Ivor Lewis Esophagectomy ◽

The Impact

Abstract To compare complications following totally minimally invasive (TMIE), laparoscopically assisted (hybrid) and open Ivor Lewis esophagectomy in patients with esophageal cancer. Three randomized trials have reported benefits for minimally invasive esophagectomy. Two studies compared TMIE versus open esophagectomy and another compared hybrid versus open Ivor Lewis esophagectomy. Only small retrospective studies compared TMIE with hybrid Ivor Lewis esophagectomy. Methods Data were used from the International Esodata Study Group assessing patients undergoing TMIE, hybrid or open Ivor Lewis esophagectomy. Primary outcome was pneumonia, secondary outcomes included incidence and severity of anastomotic leakage, (major) complications, length of stay, escalation of care and 90-day mortality. Data were analyzed using multivariate multilevel models. Results In total, 4733 patients were included in this study (TMIE:1472, hybrid:1364 and open:1897). Patients undergoing TMIE had lower incidence of pneumonia compared to hybrid (10.9% vs 16.3%, Odds Ratio (OR):0.56, 95%CI: 0.40–0.80) and open esophagectomy (10.9% vs 17.4%, OR:0.60, 95%CI: 0.42–0.84) and had shorter length of stay (median 10 days (IQR 8–16)) compared to hybrid (14 (11–19), p = 0.041) and open esophagectomy (11 (9–16), p = 0.027). Patients undergoing TMIE had higher rate of anastomotic leakage compared to hybrid (15.1% vs 10.7%, OR:1.47, 95%CI: 1.01–2.13) and open esophagectomy (7.3%, OR:1.73, 95%CI: 1.26–2.38). No differences were reported between hybrid and open esophagectomy. Conclusion Compared to hybrid and open Ivor Lewis esophagectomy, TMIE resulted in a lower pneumonia rate, a shorter hospital length of stay but a higher anastomotic leakage rate. The impact of these individual complications on survival and long-term quality of life should be further investigated.

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