20. A novel suction-drainage system to treat anastomotic leakage after totally minimally invasive esophagectomy with intrathoracic anastomosis (Ivor Lewis)

2016 ◽  
Vol 42 (9) ◽  
pp. S73
Author(s):  
M. Lubbers ◽  
M. Van Det ◽  
A. Van der Linden ◽  
A. Vrij ◽  
E. Kouwenhoven
Keyword(s):  
Minimally Invasive ◽  
Anastomotic Leakage ◽  
Minimally Invasive Esophagectomy ◽  
Drainage System ◽  
Suction Drainage ◽  
Ivor Lewis ◽  
Intrathoracic Anastomosis ◽  
Invasive Esophagectomy

End to side circular stapled anastomosis during robotic-assisted Ivor Lewis minimally invasive esophagectomy (RAMIE)

2022 ◽  
Author(s):  
Giovanni Capovilla ◽  
Edin Hadzijusufovic ◽  
Evangelos Tagkalos ◽  
Caterina Froiio ◽  
Felix Berlth ◽  
...  
Keyword(s):  
Esophageal Cancer ◽  
Minimally Invasive ◽  
Primary Outcome ◽  
Minimally Invasive Esophagectomy ◽  
Postoperative Mortality ◽  
The Other ◽  
Ivor Lewis ◽  
Robotic Assisted ◽  
Intrathoracic Anastomosis ◽  
Invasive Esophagectomy

Abstract Robotic-assisted minimally invasive esophagectomy (RAMIE) represents an established approach for the treatment of esophageal cancer. Aim of this study is to evaluate the feasibility and safety of our technique for performing the intrathoracic anastomosis during RAMIE.All the procedures were performed by the same surgeon using the same technique for performing the intrathoracic anastomosis. Intraoperative and postoperative outcomes were recorded. Postoperative complications were classified according to the Esophagectomy Complications Consensus Group (ECCG); the primary outcome was the evaluation of the feasibility and safety of our technique. From 2016 to 2021, 204 patients underwent Ivor Lewis RAMIE at our Center. Two patients (0.9%) were converted during the thoracic phase. The anastomosis was completed in all the other patients forming complete anastomotic rings. The median duration for the robotic-assisted thoracoscopic phase was 224 minutes. Twenty-two of the RAMIE-Ivor Lewis patients had an anastomotic leakage (10.3%). The overall 90-day postoperative mortality was 1.9%. The procedure resulted to be feasible and safe in our cohort of patients.

O102 FINDING FACTORS ASSOCIATED WITH SAFE IMPLEMENTATION OF IVOR LEWIS TOTALLY MINIMALLY INVASIVE ESOPHAGECTOMY

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
◽  
Linda Claassen ◽  
Frans van Workum ◽  
Maroeska M Rovers ◽  
Gerjon Hannink ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Anastomotic Leakage ◽  
Minimally Invasive Esophagectomy ◽  
Learning Curves ◽  
Secondary Outcome ◽  
Ivor Lewis ◽  
Invasive Esophagectomy ◽  
Factors Associated ◽  
Surgeon Experience ◽  
Efficient Learning

Abstract Aim To define factors associated with more efficient learning after implementation of Ivor Lewis totally minimally invasive esophagectomy (TMIE). Background and Methods It is unknown which factors are associated with more efficient learning after implementation of Ivor Lewis TMIE. Prospectively collected data of 15 European expert centers are retrospectively analyzed. Consecutive patients undergoing Ivor Lewis TMIE are included. The primary outcome is anastomotic leakage and the secondary outcome is textbook outcome (TBO). The pre-defined level of acceptance for anastomotic leakage is set at 8% with a 5% margin. Trends in outcome parameters are plotted using weighted moving average to define when the pre-defined level of acceptance is reached. Outcome trends are compared between groups of hospitals for the following factors: hospital volume, surgeon experience, overall TMIE experience, expert clinic visit, Ivor Lewis TMIE course followed and Ivor Lewis TMIE proctor supervision during implementation. Results This study included 1718 patients. Hospitals with a volume >50 cases per year reached the pre-defined level of acceptance for anastomotic leakage at case 114, hospitals with a volume <50 cases did not reach the pre-defined level of acceptance. Hospitals with surgeon experience >10 years and <10 years reached the pre-defined level of acceptance at case 112 and 135, respectively. Hospitals with overall TMIE experience >50 cases and <50 cases reached the pre-defined level of acceptance at case 45 and 112, respectively. Visiting an expert clinic, followed a TMIE course, or implementation under a proctor’s supervision did not contribute to reaching the level of acceptance earlier. Conclusion Learning curves are shorter and the level of acceptance is reached earlier if Ivor Lewis TMIE is implemented in a high-volume hospital, if the procedure is implemented in a hospital with a surgeon with >10 years of experience, or if the surgeon has experience in other types of TMIE of >50 cases. These findings can inform surgeons and can contribute to formulate evidence-based training programs.

The Comparisons of Three Stapler Placement Methods for Intrathoracic Mechanistic Circular Stapling in Ivor Lewis Minimally Invasive Esophagectomy

2021 ◽  
Author(s):  
Bo Zhang ◽  
Zi xiang Wu ◽  
Qi Wang ◽  
Sai Bo Pan ◽  
Lian Wang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Minimally Invasive ◽  
Anastomotic Leakage ◽  
Minimally Invasive Esophagectomy ◽  
Multivariable Analysis ◽  
Esophageal Reconstruction ◽  
Ivor Lewis ◽  
Anastomotic Complications ◽  
Invasive Esophagectomy ◽  
The Impact

Abstract Objectives: To analyze the impact of the reversal penetrating technique (RPT) for intrathoracic gastroesophageal mechanical anastomosis on the development of anastomotic complications in Ivor Lewis minimally invasive esophagectomy (ILMIE) and further identify the risk factors for the development of anastomotic leakage and stricture.Methods: A retrospective observational study was conducted using clinical data of 316 patients with esophageal carcinoma (EC) who underwent ILMIE from January 2012 to December 2019. The participants were divided into three groups of RPT, transoral Orvil technique (TOT), or purse-string technique (PST) according to the different stapler placenent methods for intrathoracic mechanistic circular stapling. Multivariable analysis was performed to investigate the association of risk factors with anastomotic leakage and stricture.Results: There were 154 patients with RPT, 78 with TOT and 84 with PST intrathoracic gastroesophageal circular stapling in ILMIE. There was no differences in intraoperative anastomosis related conditions inclouding conversion of open operations, ways of esophageal reconstruction, lymph nodes harvested between the three groups. Whereas, The mean total operative time, and gastroesophageal anastomosis time in the RPT group were significantly shorter than those in other groups (both p<0.05). The rates of anastomotic leakage and stricture showed no statistical differences between three groups, respectively (Leakage: p=0.941; Stricture: p=0.942). Multivariate analysis revealed that the PRT method of the anvil placement does not increase the probability of anastomotic leakage (PRT: reference; TOT: odds ratio(OR) 2.845, P=0.255; PST: OR 2.234, p=0.242) and stricture (PRT: reference; TOT: OR 1.976, P=0.556; PST: OR 1.872, p=0.284).Conclusions: The PRT method of the anvil placement for intrathoracic gastroesophageal circular stapling does not increase the risk of anastomotic complications in ILMIE, but had significantly shorter surgical time and anastomosis time.

scholarly journals Technical details of the hand-sewn and circular-stapled anastomosis in robot-assisted minimally invasive esophagectomy

2020 ◽  
Vol 33 (Supplement_2) ◽  
Author(s):  
Eline M de Groot ◽  
Thorben Möller ◽  
B Feike Kingma ◽  
Peter P Grimminger ◽  
Thomas Becker ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Anastomotic Leakage ◽  
Moving Average ◽  
Minimally Invasive Esophagectomy ◽  
High Volume ◽  
Stapled Anastomosis ◽  
Robot Assisted ◽  
Intrathoracic Anastomosis ◽  
Invasive Esophagectomy ◽  
Technical Details

SUMMARY The circular mechanical and hand-sewn intrathoracic anastomosis are most often used in robot-assisted minimally invasive esophagectomy (RAMIE). The aim of this study was to describe the technical details of both techniques that were pioneered in two high volume centers for RAMIE. A prospectively maintained database was used to identify patients with esophageal cancer who underwent RAMIE with intrathoracic anastomosis. The primary outcome was anastomotic leakage, which was analyzed using a moving average curve. For the hand-sewn anastomosis, video recordings were reviewed to evaluate number of sutures and distances between the anastomosis and the longitudinal staple line or gastric conduit tip. Between 2016 and 2019, a total of 68 patients with a hand-sewn anastomosis and 60 patients with a circular-stapled anastomosis were included in the study. For the hand-sewn anastomosis, the moving average curve for anastomotic leakage (including grade 1–3) started at a rate of 40% (cases 1–10) and ended at 10% (cases 59–68). For the circular-stapled anastomosis, the moving average started at 10% (cases 1–10) and ended at 20% (cases 51–60). This study showed the technical details and refinements that were applied in developing two different anastomotic techniques for RAMIE. Results markedly improved during the period of development with specific changes in technique for the hand-sewn anastomosis. The circular-stapled anastomosis showed a more stable rate of performance.

scholarly journals European consensus on essential steps of Minimally Invasive Ivor Lewis and McKeown Esophagectomy through Delphi methodology

2021 ◽  
Author(s):  
Yassin Eddahchouri ◽  
◽  
Frans van Workum ◽  
Frits J. H. van den Wildenberg ◽  
Mark I. van Berge Henegouwen ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Expert Panel ◽  
Minimally Invasive Esophagectomy ◽  
Round Table ◽  
Round Table Discussion ◽  
Ivor Lewis ◽  
Delphi Methodology ◽  
Invasive Esophagectomy ◽  
European Consensus ◽  
Mckeown Esophagectomy

Abstract Background Minimally invasive esophagectomy (MIE) is a complex and technically demanding procedure with a long learning curve, which is associated with increased morbidity and mortality. To master MIE, training in essential steps is crucial. Yet, no consensus on essential steps of MIE is available. The aim of this study was to achieve expert consensus on essential steps in Ivor Lewis and McKeown MIE through Delphi methodology. Methods Based on expert opinion and peer-reviewed literature, essential steps were defined for Ivor Lewis (IL) and McKeown (McK) MIE. In a round table discussion, experts finalized the lists of steps and an online Delphi questionnaire was sent to an international expert panel (7 European countries) of minimally invasive upper GI surgeons. Based on replies and comments, steps were adjusted and rephrased and sent in iterative fashion until consensus was achieved. Results Two Delphi rounds were conducted and response rates were 74% (23 out of 31 experts) for the first and 81% (27 out of 33 experts) for the second round. Consensus was achieved on 106 essential steps for both the IL and McK approach. Cronbach’s alpha in the first round was 0.78 (IL) and 0.78 (McK) and in the second round 0.92 (IL) and 0.88 (McK). Conclusions Consensus among European experts was achieved on essential surgical steps for both Ivor Lewis and McKeown minimally invasive esophagectomy.

scholarly journals Robotic assisted minimally invasive esophagectomy: Ivor-Lewis approach

2021 ◽  
Vol 5 ◽  
pp. 21-21
Author(s):  
Kelsey Musgrove ◽  
Charlotte R. Spear ◽  
Jahnavi Kakuturu ◽  
Britney R. Harris ◽  
Fazil Abbas ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Minimally Invasive Esophagectomy ◽  
Ivor Lewis ◽  
Robotic Assisted ◽  
Invasive Esophagectomy

scholarly journals Totally minimally invasive esophagectomy versus hybrid minimally invasive esophagectomy: systematic review and meta-analysis

2020 ◽  
Vol 33 (8) ◽  
Author(s):  
Frans van Workum ◽  
Bastiaan R Klarenbeek ◽  
Nikolaj Baranov ◽  
Maroeska M Rovers ◽  
Camiel Rosman
Keyword(s):  
Sensitivity Analysis ◽  
Minimally Invasive ◽  
Minimally Invasive Esophagectomy ◽  
Meta Analysis ◽  
Leakage Rate ◽  
Ivor Lewis ◽  
Invasive Esophagectomy ◽  
Lymph Node Count ◽  
Randomized Controlled ◽  
Node Count

Summary Minimally invasive esophagectomy is increasingly performed for the treatment of esophageal cancer, but it is unclear whether hybrid minimally invasive esophagectomy (HMIE) or totally minimally invasive esophagectomy (TMIE) should be preferred. The objective of this study was to perform a meta-analysis of studies comparing HMIE with TMIE. A systematic literature search was performed in MEDLINE, Embase, and the Cochrane Library. Articles comparing HMIE and TMIE were included. The Newcastle–Ottawa scale was used for critical appraisal of methodological quality. The primary outcome was pneumonia. Sensitivity analysis was performed by analyzing outcome for open chest hybrid MIE versus total TMIE and open abdomen MIE versus TMIE separately. Therefore, subgroup analysis was performed for laparoscopy-assisted HMIE versus TMIE, thoracoscopy-assisted HMIE versus TMIE, Ivor Lewis HMIE versus Ivor Lewis TMIE, and McKeown HMIE versus McKeown TMIE. There were no randomized controlled trials. Twenty-nine studies with a total of 3732 patients were included. Studies had a low to moderate risk of bias. In the main analysis, the pooled incidence of pneumonia was 19.0% after HMIE and 9.8% after TMIE which was not significantly different between the groups (RR: 1.46, 95% CI: 0.97–2.20). TMIE was associated with a lower incidence of wound infections (RR: 1.81, 95% CI: 1.13–2.90) and less blood loss (SMD: 0.78, 95% CI: 0.34–1.22) but with longer operative time (SMD:-0.33, 95% CI: −0.59—-0.08). In subgroup analysis, laparoscopy-assisted HMIE was associated with a higher lymph node count than TMIE, and Ivor Lewis HMIE was associated with a lower anastomotic leakage rate than Ivor Lewis TMIE. In general, TMIE was associated with moderately lower morbidity compared to HMIE, but randomized controlled evidence is lacking. The higher leakage rate and lower lymph node count that was found after TMIE in sensitivity analysis indicate that TMIE can also have disadvantages. The findings of this meta-analysis should be considered carefully by surgeons when moving from HMIE to TMIE.

P103 A HAND-SEWN INTRATHORACIC ANASTOMOSIS IN ROBOT-ASSISTED MINIMALLY INVASIVE ESOPHAGECTOMY (RAMIE): A DETAILED DESCRIPTION OF TECHNIQUE AND OUTCOMES

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
E M de Groot ◽  
B F Kingma ◽  
R van Hillegersberg ◽  
J P Ruurda
Keyword(s):  
Anastomotic Leakage ◽  
Moving Average ◽  
Minimally Invasive Esophagectomy ◽  
Leakage Rate ◽  
Gastric Conduit ◽  
Robot Assisted ◽  
Intrathoracic Anastomosis ◽  
Invasive Esophagectomy ◽  
Anastomotic Leakage Rate ◽  
Technical Details

Abstract Aim The aim of this study was to describe a technique that was developed and refined to construct a hand-sewn intrathoracic anastomosis during robot-assisted minimally invasive esophagectomy (RAMIE). Background & Methods Whilst some case series have reported promising results of a hand-sewn intrathoracic anastomosis during RAMIE, the exact techniques were often not described in detail. Therefore, the current single-center retrospective study was designed to provide a detailed and reproducible technical description of a hand-sewn, intrathoracic anastomosis that was developed and refined for patients who underwent RAMIE in a high volume center for esophageal cancer surgery (2016-2018). Video recordings were reviewed to evaluate technical details regarding the anastomosis, including number of sutures and distances between the anastomosis and the longitudinal staple line or gastric conduit tip. Technical details and distances were extracted and measured by using video analysis software. Moving average analyses were performed to evaluate whether the anastomotic leakage rate changed over the consecutive cases. Results A total of 68 patients were included in the study. For creation of the anastomosis, the gastric conduit was opened on a median distance of 19 millimeters (range 0-66) from the gastric conduit tip. After initially performing end-to-end anastomoses, a switch was made to an end-to-side anastomosis for the majority of 55 patients (81%). A median total of 27 sews (range 20-38) were required to close the anastomosis. In the last 22 patients of the cohort (32%), 4 tension release stitches were placed after circular suturing of the anastomosis. A re-inforcing omental wrap was positioned around the anastomosis in 64 patients (94%). The moving average curve for anastomotic leakage started at a rate of 40% (cases 1-10) and ended at 10% (cases 59-68). Conclusion This is the first study to report technical features and outcomes of a hand-sewn intrathoracic anastomosis during RAMIE in detail. Although an acceptable anastomotic leakage rate was observed in the final inclusion phase, a hand-sewn intrathoracic anastomosis during RAMIE may carry a substantial learning curve.

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