661 EFFICACY OF ROBOT ASSISTED MINIMALLY INVASIVE ESOPHAGECTOMY: PROPENSITY MATCHED ANALYSIS OF RAMIE IN COMPARISON WITH CONVENTIONAL MIE

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Takeo Fujita ◽  
Kazuma Sato ◽  
Asako Ozaki ◽  
Tomohiro Akutsu ◽  
Hisashi Fujiwara ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Minimally Invasive Esophagectomy ◽  
Recurrent Laryngeal Nerve Paralysis ◽  
Surgical Results ◽  
Matched Cohort ◽  
Robot Assisted ◽  
Nerve Paralysis ◽  
Invasive Esophagectomy ◽  
Significant Difference ◽  
The Difference

Abstract   Robot assisted minimally invasive esophagectomy (RAMIE) has been reported to be potential advantages in previous reports. Here we demonstrate the difference between these two minimally invasive procedures and investigated the surgical results of RAMIE in comparison with MIE using propensity matched-cohort. Methods We investigated 154 cases of thoracic esophagectomy conducted between 2020/1 to 2021/1. Among these cases, we analyzed 30 cases of RAMIE in comparison with 30 cases of matched-cohort which conducted conventional thoracoscopic esophagectomy (MIE) in the prone. Then we evaluated the surgical results between two groups. Results There were no differences in age (69.2 vs 69.1 yo), gender (M:F = 24:6 vs 24:6), cStage (Stage I,II,III,IV:6,3,14,7 vs 8,3,14,5), and preoperative chemotherapy (70% vs 66.7%) between RAMIE and matched-cohort MIE. There was statistically significant difference in total time of thoracic phase (233.1 vs 173.3 min; p < 0.01). There were no significant differences in postoperative events in RAMIE vs MIE (Clavien-Dindo Grade 1≧; Recurrent laryngeal nerve paralysis (RLNP) (16.7 vs 20.0%; p = 0.19). However, after the learning curve archived, seldom cases were diagnosed postoperative RLNP in RAMIE cases in comparison with MIE (p = 0.06). Conclusion We demonstrated the formalization of our procedure and surgical results of RAMIE. There were no significant differences in postoperative events between two groups. However RLNP was lower after the learning peak. Incidence of RLNP could be reduced in RAMIE.

RA01.06: TOTALLY MINIMALLY INVASIVE ESOPHAGECTOMY IN A PATIENT WITH PREVIOUS NISSEN FUNDOPLICATION: CAN INDOCYANINE GREEN BE A USEFUL TOOL?

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 19-19
Author(s):  
Victor Turrado-Rodriguez ◽  
Dulce Nombre De Maria Momblan ◽  
Alba Torroella ◽  
Ainitze Ibarzabal ◽  
Yoelimar Carolina Guzman ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Indocyanine Green ◽  
Prone Position ◽  
Nissen Fundoplication ◽  
Minimally Invasive Esophagectomy ◽  
Gastric Conduit ◽  
Recurrent Laryngeal Nerve Paralysis ◽  
Hiatal Hernia Repair ◽  
Nerve Paralysis ◽  
Invasive Esophagectomy

Abstract Description Total esophagectomy may be technically demanding. Previous abdominal surgeries may increase the difficulty of the technique, especially when affecting the stomach as a gastric conduit is the preferred method for reconstruction. In this video, we demonstrate that the creation of the gastric conduit is feasible even with a previous Nissen fundoplication and that the use of indocyanine green (ICG) is useful to assess the vascularization of the gastric conduit. Methods A 70-year-old woman with medical history of high blood pressure, hysterectomy and hiatal hernia repair with laparoscopic Nissen fundoplication presented with symptoms of dysphagia and weight loss and was diagnosed of an adenocarcinoma of the esophagus (25 to 32 cm from the incisives) cT3N1. Neoadjuvant chemo-radiotherapy following CROSS scheme was administered. A total minimally invasive esophagectomy was performed in the prone position for the thoracic time. Concerns about the length of the gastric conduit due to the fundoplication were present during surgery. ICG was used to locate the right gastroepiploic arcade, asses the vascularization of the gastric conduit, specially in the gastric fundus, and after cervicotomy, to assess the vascularization of the gastric stump before performing the anastomosis. Results Surgical time was 360 minutes. Postoperative evolution was satisfactory except for hoarseness due to a possible right recurrent laryngeal nerve paralysis. She was discharged on the 11th postoperative day. Pathology confirmed an adenocarcinoma of the mid esophagus ypT1bN1 (1/15). Conclusions Totally minimally invasive esophagectomy in the prone position is feasible even in the case of previous upper gastrointestinal surgeries, such as Nissen fundoplication. The use of ICG is useful for the identification of the gastroepiploic arcade, assessment of the vascular supply to the gastric conduit and to the anastomosis, especially when a McKeown esophagectomy is performed. Disclosure All authors have declared no conflicts of interest.

scholarly journals Robot-assisted minimally invasive esophagectomy (RAMIE): tips and tricks from the bedside assistant view—expert experiences

2020 ◽  
Vol 33 (Supplement_2) ◽  
Author(s):  
S van der Horst ◽  
C Voli ◽  
I A Polanco ◽  
R van Hillegersberg ◽  
J P Ruurda ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Minimally Invasive Esophagectomy ◽  
Da Vinci Surgical System ◽  
Robot Assisted ◽  
Communicative Skills ◽  
Invasive Esophagectomy ◽  
Bedside Assistant ◽  
Vinci Surgical System ◽  
Surgical System

ABSTRACT The role of bedside assistants in robot-assisted minimally invasive esophagectomy is important. It includes knowledge of the procedure, knowledge of the da Vinci Surgical System, skills in laparoscopy, and good communicative skills. An experienced bedside assistant will likely improve efficiency and safety of robot-assisted minimally invasive esophagectomy.

Extracorporeal Gastric Stapling Reduces the Incidence of Gastric Conduit Failure after Minimally Invasive Esophagectomy

2010 ◽  
Vol 76 (8) ◽  
pp. 823-828 ◽  
Author(s):  
Gregory D. Crenshaw ◽  
Suven S. Shankar ◽  
Russell E. Brown ◽  
Abbas E. Abbas ◽  
John S. Bolton
Keyword(s):  
Minimally Invasive ◽  
Anastomotic Leak ◽  
Operative Mortality ◽  
Minimally Invasive Esophagectomy ◽  
Gastric Conduit ◽  
Short Term ◽  
Simple Modification ◽  
Invasive Esophagectomy ◽  
Clinic Foundation ◽  
Significant Difference

Esophageal cancer resection is associated with significant morbidity and mortality. To date, no standardized technique exists. In this study, we analyze our short-term results in 92 minimally invasive resections performed over the past 10 years in an attempt to identify technical factors, which contribute to improved short-term outcomes. A retrospective review of 92 minimally invasive esophagectomies was performed at the Ochsner Clinic Foundation from 1999 through 2009. Data collected included preoperative stage, whether or not preoperative chemoradiation was used, technique of minimally-invasive resection, technique of esophagogastric anastomosis, margin status, anastomotic leak, conduit necrosis, gastric conduit failure of any type, and operative mortality. Gastric stapling was done either laparoscopically (intracorporeal) or through a minilaparotomy (extracorporeal). Ninety-two patients met criteria for this study. There was a significant difference in the incidence of positive gastric margins ( P = 0.04), anastomotic leak ( P = 0.045), conduit necrosis ( P = 0.03), and any gastric conduit failure ( P = 0.02) favoring the extracorporeal group. The overall short-term morbidity and operative mortality with minimally invasive esophagectomy is comparable to the results obtained with open techniques. A relatively simple modification of the operative technique—performing extracorporeal stapling of the gastric conduit—led to a significant reduction in the incidence of gastric conduit failures when compared with the intracorporeal stapling technique.

scholarly journals Robot-assisted minimally invasive esophagectomy (RAMIE) improves perioperative outcomes: a review

2019 ◽  
Vol 11 (S5) ◽  
pp. S735-S742 ◽  
Author(s):  
B. Feike Kingma ◽  
Michiel F. G. de Maat ◽  
Sylvia van der Horst ◽  
Pieter C. van der Sluis ◽  
Jelle P. Ruurda ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Minimally Invasive Esophagectomy ◽  
Perioperative Outcomes ◽  
Robot Assisted ◽  
Invasive Esophagectomy

O100 WORLDWIDE TECHNIQUES AND OUTCOMES OF ROBOT-ASSISTED MINIMALLY INVASIVE ESOPHAGECTOMY (RAMIE): RESULTS FROM THE INTERNATIONAL UGIRA REGISTRY

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
B F Kingma ◽  
P P Grimminger ◽  
M J van Det ◽  
Y K Chao ◽  
P Chiu ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Minimally Invasive Esophagectomy ◽  
Operating Time ◽  
Case Series ◽  
Radical Resection ◽  
Pulmonary Complications ◽  
Cardiac Complications ◽  
Robot Assisted ◽  
Invasive Esophagectomy ◽  
The Mean

Abstract Aim The aim of this study was to gain insight in the techniques and outcomes of RAMIE worldwide. Background & Methods Although robot-assisted minimally invasive esophagectomy (RAMIE) is increasingly adopted. The current literature on RAMIE mainly consists of single-center case series with considerable variation in reported techniques and outcomes. To gain an overview of the worldwide practice in RAMIE, an online registry was established by the Upper GI International Robotic Association (UGIRA). The collected data involve patient- and treatment characteristics, as well as postoperative outcomes that include complications as defined by the Esophageal Complications Consensus Group, length of stay, re-admissions (i.e. <30 days after discharge), mortality (i.e. in-hospital or <30 days after surgery), and pathological results. The outcomes were descriptively analyzed for this interim report. Results A total of 434 patients who underwent RAMIE for esophageal cancer between 2016-2019 were included in this interim analysis. The mean age was 63 years (SD ±9.7), the majority was male (n=359, 83%), and nearly all patients had an ASA score ≥2 (n=398, 92%). Adenocarcinoma (n=253, 58%) and squamous cell carcinoma (n=162, 37%) were most prevalent. The usual surgical approach was transthoracic (n=428, 99%) with the patient in semiprone position (n=393, 91%). Gastric conduit reconstruction was performed in all except one patient, who received a colonic interposition. The anastomosis was created by hand-sewing (n=207, 48%), circular stapling (n=142, 32%), or linear stapling (n=85, 20%). The median intraoperative blood loss was 120 milliliters (IQR 70-280) and the median operating time was 392 minutes (IQR 353-455). Postoperative complications occurred in 251 patients (59%) and mainly involved pulmonary complications (n=138, 32%), anastomotic leakage (n=80, 18%), and cardiac complications (n=55, 13%). Mortality occurred in 9 patients (2%) and re-admission because of complications was required in 57 patients (14%). A median of 28 lymph nodes (IQR 21-35) were removed and a radical resection was achieved in 400 patients (92%). Conclusion The presented results are the first to provide an overview of the techniques that are commonly used in RAMIE. By demonstrating results that are in line with recent benchmarking literature, this study demonstrates the safety and feasibility of RAMIE.

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