9 SURGICAL TECHNIQUES AND POTENTIAL OF MEDIASTINAL LYMPHADENECTOMY IN ROBOTIC SURGERY

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Taro Oshikiri ◽  
Gosuke Takiguchi ◽  
Naoki Urakawa ◽  
Hiroshi Hasegawa ◽  
Masashi Yamamoto ◽  
...  
Keyword(s):  
Health Insurance ◽  
Robotic Surgery ◽  
Minimally Invasive Esophagectomy ◽  
Surgical Techniques ◽  
Laryngeal Nerve ◽  
The Other ◽  
Robot Assisted ◽  
Mediastinal Lymphadenectomy ◽  
Invasive Esophagectomy ◽  
Grade Ii

Abstract   Procedure of minimally invasive esophagectomy in prone position (Conventional prone-MIE) is standardized leading to feasible short outcomes. On the other hand, robot assisted MIE (Robotic MIE) was approved as Japanese health insurance treatment since 2018. Especially, reduction of recurrent laryngeal nerve (RLN) palsy leading to aspiration pneumonia is expected for Robotic MIE. The purpose of this study is to clarify the potential of Robotic MIE for improvement of short outcomes. Methods Twenty-four Robotic MIEs in introduction period since 2018 and 128 Conventional prone-MIEs in established period since 2015 from all of the 375 cases were compared using propensity score matching. Results Operative times in both entire and thoracic procedures were significantly longer in Robotic MIE. There were no significant differences between two groups in the number of harvested lymph nodes, amount of the blood loss, left RLN palsy rate (13% vs 14%, > Clavien-Dindo classification: C-D grade I), right RLN palsy rate (4% vs 8%, > C-D grade I), and pneumonia rate (7% vs 7%, > C-D grade II). Conclusion Short outcomes of Robotic MIE in introduction period were not inferior to those of Conventional prone-MIE in established period. More improvement is expected for Robotic MIE via learning curve. In conclusion, Robotic MIE has hidden potential to outstrip Conventional prone-MIE in outcomes. Video https://www.dropbox.com/s/7byc8nsqupgetsp/2020%20ISDE%20movie%20for%20submission.wmv?dl=0.

263 MEDIASTINAL LYMPHADENECTOMY UNDER LAPAROSCOPIC ASSISTED SINGLE-PORT INFLATABLE MEDIASTINOSCOPY THROUGH LEFT NECK APPROACH

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Xiangfeng Gan ◽  
Xiaojian Li ◽  
Qingdong Cao
Keyword(s):  
Single Port ◽  
Main Bronchus ◽  
Minimally Invasive Esophagectomy ◽  
Surgical Techniques ◽  
Lower Edge ◽  
Mediastinal Lymphadenectomy ◽  
Invasive Esophagectomy ◽  
Surgical Methods ◽  
Left Neck ◽  
The Right

Abstract   Minimally invasive esophagectomy (MIE) has developed for decades. However, conventional MIE requires transthoracic operation, it could increase the risk of many perioperative cardiopulmonary complications. Therefore, mediastinoscopy-assisted transhiatal esophagectomy has been proposed, but the traditional surgical methods have shortcomings, such as unclear vision, especially during the dissection of mediastinal lymph nodes. A new approach of mediastinal lymphadenectomy under single-port inflatable mediastinoscopy through one left-neck incision was proposed. Methods With pneumomediastinum, esophagectomy was to be performed over the aortic arch to the level of lower edge of the left main bronchus, and the lymphadenectomy of 106recL has also accomplished during this process. At the level of lower edge of the right subclavian artery (RSA), between the trachea and the esophagus, the instruments could get accessed to the right RLN. The lymphadenectomy could get accomplished up to 2-cm at the upper edge of the RSA. Between the trachea and esophagus, the lymphadenectomy of 107 would be performed along the trailing edge of the trachea down to the carina. Results 56 patients with esophageal squamous cell carcinoma from March to September 2019 who underwent this operation. The mean age of 56 patients was 67.4 years, 46 were males, and 10 were females. Preoperative TNM staging: T1b, 10 cases; T2, 35 cases; and T3, 11 cases. The median number of mediastinal LNs removed was 17 (9 to 23); 6 (2 to 9) along the left RLN; 3 (1 to 6) along the right RLN. 7 patients (12.5%) developed RLN palsy. All of the 7 RLN palsy were left side, none of them appeared at 3-month postoperation. Conclusion This single-port inflatable mediastinoscopy technology could remove the upper mediastinal LNs on both sides with a single incision on the left neck, avoid trauma to the right neck. The bilateral RLN could be clearly exposed and protected under the mediastinoscopy. Compared with previous surgical techniques, this surgery is less invasive, and the bilateral RLN is more clearly revealed. The surgical procedure described here is the first mediastinal lymphadenectomy under mediastinoscopy through one single left-neck incision. Video https://www.jianguoyun.com/p/DUvIaIsQoPWPBhj1mt8C.

scholarly journals Impact of Acoustic and Interactive Disruptive Factors during Robot-Assisted Surgery—A Virtual Surgical Training Model

Sensors ◽  
2020 ◽  
Vol 20 (20) ◽  
pp. 5891
Author(s):  
Magret Krüger ◽  
Johannes Ackermann ◽  
Daniar Osmonov ◽  
Veronika Günther ◽  
Dirk Bauerschlag ◽  
...  
Keyword(s):  
Robotic Surgery ◽  
Video Games ◽  
Surgical Techniques ◽  
Training Model ◽  
German Society ◽  
Surgical Experience ◽  
Robot Assisted ◽  
Cross Sectional ◽  
Significant Difference ◽  
The Impact

The use of virtual reality trainers for teaching minimally invasive surgical techniques has been established for a long time in conventional laparoscopy as well as robotic surgery. The aim of the present study was to evaluate the impact of reproducible disruptive factors on the surgeon’s work. In a cross-sectional investigation, surgeons were tested with regard to the impact of different disruptive factors when doing exercises on a robotic-surgery simulator (Mimic Flex VRTM). Additionally, we collected data about the participants’ professional experience, gender, age, expertise in playing an instrument, and expertise in playing video games. The data were collected during DRUS 2019 (Symposium of the German Society for Robot-assisted Urology). Forty-two surgeons attending DRUS 2019 were asked to participate in a virtual robotic stress training unit. The surgeons worked in various specialties (visceral surgery, gynecology, and urology) and had different levels of expertise. The time taken to complete the exercise (TTCE), the final score (FSC), and blood loss (BL) were measured. In the basic exercise with an interactive disruption, TTCE was significantly longer (p < 0.01) and FSC significantly lower (p < 0.05). No significant difference in TTCE, FSC, or BL was noted in the advanced exercise with acoustic disruption. Performance during disruption was not dependent on the level of surgical experience, gender, age, expertise in playing an instrument, or playing video games. A positive correlation was registered between self-estimation and surgical experience. Interactive disruptions have a greater impact on the performance of a surgeon than acoustic ones. Disruption affects the performance of experienced as well as inexperienced surgeons. Disruption in daily surgery should be evaluated and minimized in the interest of the patient’s safety.

270 LYMPHADENECTOMY ALONG BILATERAL RECURRENT LARYNGEAL NERVE UNDER SINGLE-PORT INFLATABLE MEDIASTINOSCOPY THROUGH LEFT NECK APPROACH

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
X Wu ◽  
X Gan ◽  
Q Cao
Keyword(s):  
Minimally Invasive ◽  
Recurrent Laryngeal Nerve ◽  
Minimally Invasive Esophagectomy ◽  
Cell Cancer ◽  
Laryngeal Nerve ◽  
Lower Edge ◽  
Invasive Esophagectomy ◽  
Surgical Methods ◽  
Left Neck ◽  
The Right

Abstract   Mediastinal lymphadenectomy is a crucial part of minimally invasive esophagectomy, and requires transthoracic operation, which is a crucial independent risk factor for the incidence of pulmonary complications. Conventionally, non-transthoracic esophagectomy was often achieved by mediastinoscope-assisted laparoscopic transhiatal surgery. Because of the small space, the lymphadenectomy could be only performed partially under mediastinoscope in upper mediastinal. We propose a new approach of lymphadenectomy along bilateral recurrent laryngeal nerve under mediastinoscopy through one left-neck incision. Methods A 3-cm incision paralleling the clavicle was made at 2-cm from the supraclavicular region in the left neck. After established pneumomediastinum (10-12 mmHg carbon dioxide), esophagectomy begins to perform over the aortic arch to the level of lower edge of the left main bronchus, and the lymphadenectomy along the left RLN has also accomplished during this process. At the level of lower edge of the right subclavian artery (RSA), between the trachea and the esophagus, the instruments could get accessed to the right RLN. The lymphadenectomy could get accomplished up to 2-cm at the upper edge of the RSA. Results The mean age of 56 esophageal squamous cell cancer patients was 67.4 years, 46 males and 10 females. Tumor location: middle thoracic, 31 patients, lower thoracic, 23 patients. Preoperative TNM staging: T1b was 10 cases, T2 was 35 cases, and T3 was 11 cases. The median number of mediastinal LNs removed was 17 (9 to 23); 6 (2 to 9) along the left RLN; 3 (1 to 6) along the right RLN. 7 patients (12.5%) developed RLN palsy. Postoperative laryngoscopy showed that all of the 7 RLN palsy were left side, none of them appeared at 3 months postoperation. Conclusion This approach enables the lymphadenectomy along bilateral RLN through one left neck incision. During the operation, the upper mediastinal LNs along the bilateral RLN were clearly revealed and en bloc excised. Meanwhile, the bilateral RLN were fully exposed and protected during the procedure. Compared with the previous surgical methods,this procedure is less invasive, and the bilateral RLN could be exposed much clearer. It would provide a novel approach for the minimally invasive esophagectomy, especially lymphadenectomy.

Sign in / Sign up

Export Citation Format

Share Document