VS03.04: MINIMALLY INVASIVE IVOR LEWIS ESOPHAGECTOMY WITH ROBOTIC ASSISTANCE AND IMMUNOFLUORESCENCE: MODULAR STEP UP APPROACH FOR SAFE INTRODUCTION OF NEW TECHNOLOGY

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 48-48
Author(s):  
Hans Fuchs ◽  
Rolf Lambertz ◽  
Wolfgang Schröder ◽  
Jessica Leers ◽  
Christiane Bruns
Keyword(s):  
Minimally Invasive ◽  
New Technologies ◽  
Conflicts Of Interest ◽  
New Technology ◽  
Gastrointestinal Surgery ◽  
Ivor Lewis ◽  
Ivor Lewis Esophagectomy ◽  
Center Of Excellence ◽  
Academic Center ◽  
Upper Gastrointestinal

Abstract Description Minimally invasive technologies have improved outcomes after esophagectomy and the use of robotic technology in Europe is rapidly increasing. Aim of this study is to evaluate the introduction of new technologies in a center of excellence for upper gastrointestinal surgery. Methods A standardized teaching protocol of a complete OR team was performed in simulation and animal models at the center for the future of surgery (San Diego, CA) and IRCAD (Strasbourg, France) to receive certification as console surgeons. Starting 02/2017 the davinci xi and stryker ICG laparoscopy systems were introduced at our academic center (certified center of excellence for surgery of the upper gastrointestinal tract, n > 300 esophageal cases/year). After simple training procedures based on our minimally invasive expertise were performed, difficulty was increased based on a modular step up approach to safely perform robotic thoracic assisted Ivor Lewis esophagectomy. Results From 02/2017–02/2018, a total of 35 robotic cases were performed. All cases were performed safely without operation-associated complications. Level of difficulty was increased based on our modular step up approach without quality compromises. Video documentation using the new technology is provided. Conclusion The standardized training protocol and our modular step up approach allowed safe introduction of the new technology used. All cases were performed safely without operation-associated complications. Disclosure All authors have declared no conflicts of interest.

P131 REVEALING THE ERGONOMIC CRISIS OF AN UPPER GASTROINTESTINAL ROBOTIC SURGEON – STILL A LOT TO IMPROVE IN MINIMALLY INVASIVE SURGERY

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
H Fuchs ◽  
F Ahn ◽  
J Leers ◽  
W Schröder ◽  
C Höfler ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
New Technology ◽  
Intraoperative Complications ◽  
Gastrointestinal Surgery ◽  
Robotic System ◽  
Perioperative Outcomes ◽  
Robotic Technology ◽  
Center Of Excellence ◽  
Touch Sensor ◽  
Upper Gastrointestinal

Abstract Introduction/Aim Minimally invasive technologies have improved outcomes after esophagectomy and the use of robotic technology in Europe is rapidly increasing. Even though robotic technology was primarily developed to improve perioperative outcomes, many robotic surgeons complain about ergonomics when using existing devices. Aim of this study is to evaluate the ergonomics of the newest robotic technology in a center of excellence for upper gastrointestinal surgery. Background and Methods Starting 02/2017 the latest available robotic system (davinci xi) was introduced at our academic center (certified center of excellence for surgery of the upper gastrointestinal tract, n>300 esophageal cases/year). Surgeons ergonomics were studied using a standardized video capture and touch sensor protocol (Fig 1 & 2). Data recorded were analyzed to study whether the new robotic system was used in an ergonomic fashion throughout robotic esophageal surgery. Results From 02/2017 – 05/2019, a total of 90 mainly upper gastrointestinal robotic cases including 45 Esophagectomies for cancer and 25 Heller Myotomies were performed. All cases were performed safely without operation-associated intraoperative complications. Even though experienced robotic console surgeons used the robotic device, the davinci xi arm rest was used in less than 25% of surgery time (Fig. 3), resulting in loss of efficacy when using the robotic range of motion. Video documentation using the new technology is provided to showcase the dilemma. Conclusion Robotic technology allows for safe minimally invasive upper gastrointestinal surgery. Further development in robotics should focus on improvement of surgeons ergonomics.

scholarly journals Simplified nutritional scoring system predicts complicated outcomes of upper gastrointestinal surgery

2017 ◽  
Author(s):  
Juyong Cheong ◽  
Gregory Leighton Falk ◽  
Jigar Darji
Keyword(s):  
Postoperative Complications ◽  
Gastrointestinal Surgery ◽  
Subtotal Gastrectomy ◽  
Postoperative Outcome ◽  
Bowel Function ◽  
Ivor Lewis ◽  
Ivor Lewis Esophagectomy ◽  
The Mean ◽  
The Relationship ◽  
Upper Gastrointestinal

Abstract Introduction: Postoperative complications after major upper gastrointestinal surgery can be devastating. Malnutrition has been found to be an important risk factor for postoperative complications. However, attempts at trying to detect malnourished patients preoperatively can be cumbersome and complex and are often not done. One simplified way of assessing nutritional status is the ANS system. The aim of this study was to show the relationship between ANS score and the postoperative outcome. Methodology: Medical record of all patients undergoing major EG and HB surgeries at Concord Hospital between 2010 and 2012 were retrospectively analysed. Results: 83 patients were operated and included (1) Whipples' procedure (20.5%), (2) total/subtotal gastrectomy (44.6%), (3) Ivor-Lewis esophagectomy (18%), and (4) distal pancreatectomy (14.5%). The mean ANS score was 1.58. Patients with higher ANS score (2 or more) were found to have significantly higher rates of wound infection (41% vs 12%, p<0.002), anastomotic leaks (13.7% vs 1.92%, p=0.034), unexpected return to operating theatre (31% vs 3.9%, p<0.001), slower return of bowel function as compared to patients with low ANS score (0 or 1). Conclusion: This study demonstrates the importance of screening for malnourished patients prior to their operation. Given its simplicity and effective predictive value, we recommend use of ANS system.

VS03.05: VASCULAR ASSESSMENT OF THE GASTRIC TUBE IN MINIMALLY INVASIVE IVOR-LEWIS ESOPHAGECTOMY USING INDOCYANINE GREEN

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 48-48
Author(s):  
Dulce Nombre De Maria Momblan ◽  
Victor Turrado-Rodriguez ◽  
Alba Torroella ◽  
Ainitze Ibarzabal ◽  
Arlena Sofia Espinoza ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Indocyanine Green ◽  
Conflicts Of Interest ◽  
Vascular Supply ◽  
Gastric Conduit ◽  
Leak Rate ◽  
Esophagogastric Anastomosis ◽  
Ivor Lewis ◽  
Invasive Esophagectomy ◽  
Ivor Lewis Esophagectomy

Abstract Description One of the major concerns in esophagic surgery is the safety of the esophagogastric anastomosis. Anastomotic leak is associated with important morbidity and mortality. Leak rates have been reported in 4.7% of patients in the Ivor-Lewis procedure and 5.2% for cervical anastomosis. Leak rate has been associated with insufficient vascular supply to the gastric conduit. Indocyanine green (ICG) assessment of the vascularization may be a useful tool to avoid this dreadful complication. Methods A 50-year-old man with medical history of high blood pressure and right pneumothorax was diagnosed of adenocarcinoma of the lower esophagus cT3N3. Neoadjuvant chemo-radiotherapy following CROSS principles was administered. Six weeks after the end of neoadjuvant chemo-radiotherapy a minimally invasive Ivor-Lewis esophagectomy was performed. ICG helped the identification of the right gastroepiploic arcade and of the adequate vascular supply to the gastric conduit. During thoracoscopy, ICG was helpful to assess the vascular supply to the gastric conduit after pull-up into the chest and to check the vascularization of the esophagogastric anastomosis. Results Postoperative evolution was uneventful. Oral intake was resumed on the third postoperative day. Patient was discharged on the 8th postoperative day. Conclusions ICG assessment of the vascularization of the gastric conduit is feasible, safe and helpful in Ivor-Lewis minimally invasive esophagectomy and may decrease the leak rate. Disclosure All authors have declared no conflicts of interest.

VS03.02: TOTALLY MINIMALLY INVASIVE IVORL LEWIS ESOPHAGECTOMY (TMIE) INDOCYANINE COLOR GREEN (ICG) FLUORESCENCE ANGIOGRAPHY ASSISTED

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 48-48
Author(s):  
Andrea Cossu ◽  
Paolo Parise ◽  
Francesco Puccetti ◽  
Leonardo Garutti ◽  
Carlo Ferrari ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Gastric Tube ◽  
Conflicts Of Interest ◽  
Oncologic Outcomes ◽  
Fluorescence Angiography ◽  
Technical Problems ◽  
Ivor Lewis ◽  
Experienced Surgeon ◽  
Ivor Lewis Esophagectomy ◽  
Overall Mortality

Abstract Description Totally Minimally Invasive Ivor Lewis Esophagectomy has been proven feasible and safe in terms of overall mortality, morbidity and oncologic outcomes. Technical problems still exist in anastomotic fashioning and esophagogastric leakage represents the most feared complication. Its incidence is strictly related to technical difficulties and to the ischemia of the tissue involved in the anastomosis. We think angiography with Indocyanine Color Green can help the experienced surgeon to better evaluate the adequacy of the gastric tube therefore reducing the incidence of anastomotic leak. Disclosure All authors have declared no conflicts of interest.

scholarly journals Application of robots in general surgery

2021 ◽  
Vol 64 (10) ◽  
pp. 678-687
Author(s):  
Jin Kyong Kim ◽  
Seung Yoon Yang ◽  
Sung Hyun Kim ◽  
Hyoung-Il Kim
Keyword(s):  
Robotic Surgery ◽  
Minimally Invasive ◽  
General Surgery ◽  
New Technologies ◽  
Gastrointestinal Surgery ◽  
Laparoscopic Approach ◽  
Comparative Trial ◽  
Endocrine Surgery ◽  
The Impact ◽  
Upper Gastrointestinal

Background: Application of robotic surgery in the field of general surgery has been increasing. This paper is an overview of the current uses and future perspectives of robotic surgery in four major divisions—endocrine, upper gastrointestinal, hepato-biliary-pancreatic (HBP), and colorectal surgery.Current Concepts: In endocrine surgery, cosmetic advantage is the highest priority when selecting a surgical approach for thyroidectomy. Currently, the transaxillary route is the most common approach. The introduction of the single-port system could maximize the advantages of this technique. In upper gastrointestinal surgery, the use of robots has the advantage of better retrieval of lymph nodes, less bleeding, earlier discharge, and less complications than the laparoscopic approach. However, a more prospective comparative trial is required to confirm those findings. In the HBP field, the indications of robotic surgery have expanded, starting with cholecystectomy to more challenging procedures, such as donor hepatectomy and pancreaticoduodenectomy. Meticulous dissection using robots could provide benefits to patients. In colorectal surgery, robotic surgery is an excellent technical tool for minimally invasive surgeries for rectal cancers, especially in male patients with narrow, deep pelvises. However, further studies are required to confirm the impact of robotic surgery on rectal cancers.Discussion and Conclusion: Robots are used to provide optimal surgical outcomes. Investigating new technologies and innovative surgical procedures is the highly important for a surgeon in the era of minimally invasive surgery.

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

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

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

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.

Modified Intrathoracic Esophagogastrostomy with Minimally Invasive Robot-Assisted Ivor-Lewis Esophagectomy for Cancer

2018 ◽  
Vol 36 (3) ◽  
pp. 218-225 ◽  
Author(s):  
Wen-Ping Wang ◽  
Long-Qi Chen ◽  
Han-Lu Zhang ◽  
Yu-Shang Yang ◽  
Song-Lin He ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Circular Stapler ◽  
Purse String Suture ◽  
Robot Assisted ◽  
Purse String ◽  
Ivor Lewis ◽  
Intrathoracic Anastomosis ◽  
Ivor Lewis Esophagectomy ◽  
Estimated Blood Loss ◽  
Esophagectomy For Cancer

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.

Sign in / Sign up

Export Citation Format

Share Document