P111 ROBOTIC-ASSISTED REPAIR OF IATROGENIC LEFT BRONCHUS PERFORATION DURING RAMIE – A CASE REPORT

Abstract Background Iatrogenic bronchial injury during an esophageal surgery is a severe complication. Hence, immediate treatment is necessary to avoid further pulmonary complications and death. We present a case of an intraoperative bronchial injury caused by a bronchial tube cuff during a full robotic-assisted Ivor-Lewis esophagectomy (RAMIE). Case report A 64-year old patient with adenocarcinoma of the distal esophagus was planned for a RAMIE after completing neoadjuvant radiochemotherapy. Before beginning the thoracic phase, the anesthesist reported an airway leakage during the ventilation. During the transthoracic robotic assisted esophagectomy a perforation of the left main bronchus caused by the cuff of the double-lumen tube was found. Due to the diameter of the defect (1/2 inch) direct suturing was not possible. Therefore, we used a stalked pericardial patch to robotically oversew the perforation. The precise agility using the robotic DaVinci system was very useful treating this perforation minimally- invasively during the RAMIE without conversion. The rest of the surgery including the gastric pull-up and intrathoracic anastomosis was carried out without further complication. The patient had a normal postoperative course and showed no signs of any pulmonary restrictions or any other morbidity. The patient was discharged fully enteralised and in good conditions at the 9th postoperative day. The histopathological stage was ypT3, N2(4/21), L0, V0, Pn0, R0 (stage IIIB in 7th UICC). Conclusion This case report points out the great possibilities of robotic surgery dealing with unexpected complications during complex operations. Robot-assisted complex suturing is a great advantage in robot-assisted minimally invasive surgery, especially during sewing a pericardium-flap onto the left bronchus perforation during an esophagectomy.

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Robotic-Assisted Total Pericardiectomy for Acute Relapsing Pericarditis: A Case Report

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1177/1556984519861960 ◽

2019 ◽

Vol 14 (5) ◽

pp. 468-472 ◽

Cited By ~ 1

Author(s):

Husam H. Balkhy ◽

Brooke B. Patel ◽

Robert Spiller ◽

Diego Avella-Patino

Keyword(s):

Case Report ◽

Therapeutic Option ◽

Symptomatic Patient ◽

Pharmacologic Treatment ◽

Potential Complication ◽

Robot Assisted ◽

Invasive Approach ◽

Robotic Assisted ◽

Off Pump ◽

Pacemaker Placement

Acute, relapsing pericarditis is an uncommon potential complication of any cardiothoracic intervention. If medical management fails to mitigate recurrent symptoms, robotic total pericardiectomy can be performed as a definitive therapeutic option. A 33-year-old woman had severely symptomatic, persistent pericarditis, which began 3 weeks after pacemaker placement for tachy-brady syndrome. After failure of pharmacologic treatment, a robot-assisted total pericardiectomy was performed with a drastic improvement in symptoms. Considering that this case of pericarditis was inflammatory (nonconstrictive), a radical excisional approach to all the pericardium was undertaken in order to prevent relapse of symptoms. A bilateral endoscopic off-pump robot-assisted approach was used to completely and fully excise both the anterior and posterior pericardium. In conclusion, we present a case of acute relapsing pericarditis in a very symptomatic patient who failed medical therapy and underwent a robotic totally endoscopic radical pericardiectomy with excellent results. We believe that this technique allows for total pericardiectomy using the least invasive approach and should be considered in the management of this rare but potentially debilitating condition.

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Robot-assisted resection of rectal duplication cysts: A case report

10.22541/au.163473742.28491153/v1 ◽

2021 ◽

Author(s):

Masaki Kitazono ◽

Makoto Fujita ◽

Tomohiro Oyama ◽

Naotaka Ikeda ◽

Mayumi Eguchi ◽

...

Keyword(s):

Case Report ◽

Laparoscopic Surgery ◽

Robot Assisted ◽

Large Tumor ◽

Robotic Assisted ◽

Rectal Duplication ◽

Narrow Pelvis ◽

Gastrointestinal Duplication

Rectal duplication cysts are extremely rare and account for only 4% of all gastrointestinal duplication cysts. They may become difficult for removal in the case of a large tumor in a narrow pelvis. Herein, we report a case of rectal duplication cysts excision via robotic-assisted laparoscopic surgery and its utility.

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Salvage Robotic-Assisted Thoracoscopic Esophagectomy after Definitive Chemoradiotherapy for Clinical T4b Esophageal Cancer: A Case Report

10.21203/rs.3.rs-291574/v1 ◽

2021 ◽

Author(s):

Ryohei Sasamori ◽

Satoru Motoyama ◽

Yusuke Sato ◽

Akiyuki Wakita ◽

Yushi Nagaki ◽

...

Keyword(s):

Esophageal Cancer ◽

Main Bronchus ◽

Left Main Bronchus ◽

Thoracoscopic Esophagectomy ◽

Left Main ◽

Robot Assisted ◽

Definitive Chemoradiotherapy ◽

Thoracic Esophageal Cancer ◽

Robotic Assisted ◽

Salvage Esophagectomy

Abstract BackgroundAlthough twenty years have passed since the start of robot-assisted thoracoscopic esophagectomy, salvage esophagectomy by robotic-assisted surgery has not yet been introduced by almost surgeons. Theoretically, robot-assisted thoracoscopic esophagectomy (RATE) increases operative precision and maneuverability within the narrow space of the mediastinum. However, surgeons have doubted that RATE is indicated for patients with tumor invasion of adjacent vital organs clinically (cT4b) or patients with scar tissue from definitive chemoradiotherapy. Herein, we report our case of salvage RATE for cT4b thoracic esophageal cancer which invaded to the left main bronchus before definitive chemoradiotherapy.Case presentationA man in his 60’s with middle thoracic esophageal cancer [cT4b (left main bronchus) N1 M0 cStage IIIC] received definitive chemoradiotherapy (fluorouracil and cisplatin, total radiation dose of 60 Gy). After the chemoradiotherapy, upper gastrointestinal endoscopy revealed a residual primary tumor, and we performed robotic-assisted thoracoscopic subtotal esophagectomy and gastric tube reconstruction via a retrosternal route with three-field lymphadenectomy. Although it was difficult to dissect the tumor from adjacent organs, especially in the left main bronchus and pericardium, due to the scarring after definitive chemoradiotherapy, R0 surgery was achieved. With RATE, the high-resolution three-dimensional images, stable surgical field and stable motion are considerable advantages for salvage esophagectomy for cT4b tumors. At present (30 months after surgery), the patient’s performance status is 0 and he is alive without a recurrence. ConclusionsRobot-assisted thoracoscopic esophagectomy provided considerable advantages for salvage esophagectomy after definitive chemoradiotherapy for a cT4b tumor.

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Iatrogenic thoracic aortic injury in esophagectomy – a case report and literature review

Perspectives in Surgery ◽

10.33699/pis.2019.98.6.256-259 ◽

2019 ◽

Vol 98 (6) ◽

pp. 256-259

Keyword(s):

Case Report ◽

Minimally Invasive ◽

Thoracic Aorta ◽

Aortic Rupture ◽

Hypovolemic Shock ◽

Left Lung ◽

Aortic Injury ◽

Thoracoscopic Esophagectomy ◽

Neoadjuvant Radiochemotherapy ◽

Thoracic Aortic Injury

Introduction: This case report describes bleeding from an iatrogenic thoracic aortic injury in minimally invasive thoracoscopic esophagectomy. Case report: A 53-year-old man underwent neoadjuvant radiochemotherapy for adenocarcinoma of the esophagus with positive lymph nodes. PET/CT showed only a partial response after neoadjuvant therapy. Minimally invasive thoracoscopic esophagectomy in the semi-prone position with selective intuba- tion of the left lung was performed. However, massive bleeding from the thoracic aorta during separation of the tumor resulted in conversion from minimally invasive to conventional right thoracotomy. The bleeding was caused by a five millimeter rupture of the thoracic aorta. The thoracic aortic rupture was treated by suture with a gore prosthesis in collaboration with a vascular surgeon. Esophagestomy was not completed due to hypovolemic shock. Hybrid transhiatal esophagectomy was performed on the seventh day after the primary operation. Definitive histological examination showed T3N3M0 adenocarcinoma. Conclusion: Esophagectomy for cancer of the esophagus is one of the most difficult operations in general surgery in which surgical bleeding from the surrounding structures cannot be excluded. Aortic hemorrhage is hemodynamically significant in all cases and requires urgent surgical treatment.

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