Attaining Proficiency in Robotic-Assisted Minimally Invasive Esophagectomy While Maximizing Safety during Procedure Development

Objective Robotic-assisted minimally invasive esophagectomy (RAMIE) is an emerging complex operation with limited reports detailing morbidity, mortality, and requirements for attaining proficiency. Our objective was to develop a standardized RAMIE technique, evaluate procedure safety, and assess outcomes using a dedicated operative team and 2-surgeon approach. Methods We conducted a study of sequential patients undergoing RAMIE from January 25, 2011, to May 5, 2014. Intermedian demographics and perioperative data were compared between sequential halves of the experience using the Wilcoxon rank sum test and the Fischer exact test. Median operative time was tracked over successive 15-patient cohorts. Results One hundred of 313 esophageal resections performed at our institution underwent RAMIE during the study period. A dedicated team including 2 attending surgeons and uniform anesthesia and OR staff was established. There were no significant differences in age, sex, histology, stage, induction therapy, or risk class between the 2 halves of the study. Estimated blood loss, conversions, operative times, and overall complications significantly decreased. The median resected lymph nodes increased but was not statistically significant. Median operative time decreased to approximately 370 minutes between the 30th and the 45th cases. There were no emergent intraoperative complications, and the anastomotic leak rate was 6% (6/100). The 30-day mortality was 0% (0/100), and the 90-day mortality was 1% (1/100). Conclusions Excellent perioperative and short-term patient outcomes with minimal mortality can be achieved using a standardized RAMIE procedure and a dedicated team approach. The structured process described may serve as a model to maximize patients’ safety during development and assessment of complex novel procedures.

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Costs and benefits of different methods of esophagectomy for esophageal cancer

Asian Cardiovascular and Thoracic Annals ◽

10.1177/0218492317731389 ◽

2017 ◽

Vol 25 (7-8) ◽

pp. 513-517 ◽

Cited By ~ 8

Author(s):

Alongkorn Yanasoot ◽

Kamtorn Yolsuriyanwong ◽

Sakchai Ruangsin ◽

Supparerk Laohawiriyakamol ◽

Somkiat Sunpaweravong

Keyword(s):

Esophageal Cancer ◽

Postoperative Pain ◽

Minimally Invasive ◽

Operative Time ◽

Minimally Invasive Esophagectomy ◽

Laparoscopic Approach ◽

Costs And Benefits ◽

Invasive Approach ◽

Invasive Esophagectomy ◽

Open Esophagectomy

Background A minimally invasive approach to esophagectomy is being used increasingly, but concerns remain regarding the feasibility, safety, cost, and outcomes. We performed an analysis of the costs and benefits of minimally invasive, hybrid, and open esophagectomy approaches for esophageal cancer surgery. Methods The data of 83 consecutive patients who underwent a McKeown’s esophagectomy at Prince of Songkla University Hospital between January 2008 and December 2014 were analyzed. Open esophagectomy was performed in 54 patients, minimally invasive esophagectomy in 13, and hybrid esophagectomy in 16. There were no differences in patient characteristics among the 3 groups Minimally invasive esophagectomy was undertaken via a thoracoscopic-laparoscopic approach, hybrid esophagectomy via a thoracoscopic-laparotomy approach, and open esophagectomy by a thoracotomy-laparotomy approach. Results Minimally invasive esophagectomy required a longer operative time than hybrid or open esophagectomy ( p = 0.02), but these patients reported less postoperative pain ( p = 0.01). There were no significant differences in blood loss, intensive care unit stay, hospital stay, or postoperative complications among the 3 groups. Minimally invasive esophagectomy incurred higher operative and surgical material costs than hybrid or open esophagectomy ( p = 0.01), but there were no significant differences in inpatient care and total hospital costs. Conclusion Minimally invasive esophagectomy resulted in the least postoperative pain but the greatest operative cost and longest operative time. Open esophagectomy was associated with the lowest operative cost and shortest operative time but the most postoperative pain. Hybrid esophagectomy had a shorter learning curve while sharing the advantages of minimally invasive esophagectomy.

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Intraoperative Near-Infrared Fluorescence Imaging as an Adjunct to Robotic-Assisted Minimally Invasive Esophagectomy

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1177/155698451400900513 ◽

2014 ◽

Vol 9 (5) ◽

pp. 391-393 ◽

Cited By ~ 1

Author(s):

Inderpal S. Sarkaria ◽

Manjit S. Bains ◽

David J. Finley ◽

Prasad S. Adusumilli ◽

James Huang ◽

...

Keyword(s):

Minimally Invasive ◽

Fluorescence Imaging ◽

Near Infrared ◽

Minimally Invasive Esophagectomy ◽

Near Infrared Fluorescence ◽

Robotic Assisted ◽

Invasive Esophagectomy ◽

Near Infrared Fluorescence Imaging

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Robotic assisted minimally invasive esophagectomy: Ivor-Lewis approach

Shanghai Chest ◽

10.21037/shc-2019-mies-10 ◽

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

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PS01.138: EXPERIENCE FROM 102 PATIENTS WITH CONTINUOUS INTRAOPERATIVE VAGUS NERVE STIMULATION DURING MINIMALLY INVASIVE ESOPHAGECTOMY

Diseases of the Esophagus ◽

10.1093/dote/doy089.ps01.138 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 89-89

Author(s):

Ian Yu Hong Wong ◽

Raymond King Yin Tsang ◽

Desmond Kwan Kit Chan ◽

Claudia Lai Yin Wong ◽

Tsz Ting Law ◽

...

Keyword(s):

Minimally Invasive ◽

Vocal Cord ◽

Nerve Stimulation ◽

Vocal Cord Paralysis ◽

Minimally Invasive Esophagectomy ◽

Intraoperative Complications ◽

Early Recovery ◽

Invasive Esophagectomy ◽

Assessment And Treatment

Abstract Background The incidence of recurrent laryngeal nerve (RLN) injury after esophagectomy can be as high as 60–70% especially when lymphadenectomy is performed along bilateral RLN. Vocal cord paralysis is associated with increased pulmonary complication rate, longer hospital stay, and impaired quality-of-life. The authors have modified the Continuous Intraoperative Nerve Monitoring (CIONM) method for minimally invasive esophagectomy. This study reviews our experience in the first 102 patients. Methods From May 2014 to January 2018, patients who underwent thoracoscopic esophagectomy were recruited. CIONM and intermittent nerve stimulation were routinely used during left RLN lymphadenectomy. For right RLN dissection, only intermittent nerve stimulation was used because of much lower chance of nerve injury. Routine direct laryngoscopy was performed on postoperative day one to assess the vocal cord status. Patients with RLN palsy are referred to otorhinolaryngologist for assessment and treatment. Surgical outcome, especially RLN palsy and recovery rates were documented. Results 102 patients were recruited and 73 patients had more than one year follow up. Twenty-two patients had RLN palsy (21.6%); right side in 3, left side in 18, and bilateral in one. Thirty-eight patients (37%) had only unilateral or no RLN dissection performed. This was because of R2 resection negating the benefits of RLN dissection (15.6%), poor pulmonary exposure (9.8%), other technical difficulties (7.8%), preoperative vocal cord palsy (2%), intraoperative complications (1%) and uncertain contralateral nerve integrity (1%). For those 90 patients with successful CIONM, 20 RLN palsy (22.2%), 10 of whom underwent injection thyroplasty within 2–80 days. Thyroplasty was not performed in 12 patients as they had good compensation from the contralateral cord (58.3%), early recovery within 2 weeks (16.7%) tracheostomized status (16.7%) or refusal (8.3%). Thirteen patients (59%) recovered within 2–72 weeks (Median 6 weeks). For the 73 patients with more than 1 year follow up, only 4 has residual vocal cord paralysis, making a genuine cord palsy rate of 5.5%. Conclusion Lymphadenectomy along bilateral RLN is technically demanding. CIONM is a sensitive tool to guide surgeons for safer dissection. Proper patient selection, postoperative assessment and treatment protocol can reduce the morbidity of RLN injury. Majority of the vocal cord paralysis is temporary Disclosure All authors have declared no conflicts of interest.

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A Single-Center Experience with Minimally Invasive Transgastric ERCP in Patients with Previous Gastric Bypass: Lessons Learned and Technical Considerations

The American Surgeon ◽

10.1177/000313482008600425 ◽

2020 ◽

Vol 86 (4) ◽

pp. 300-307

Author(s):

Maria Baimas-George ◽

Michael J. Passeri ◽

William B. Lyman ◽

Andrew Dries ◽

Tarun Narang ◽

...

Keyword(s):

Minimally Invasive ◽

Biliary Obstruction ◽

Operative Time ◽

Lessons Learned ◽

High Rate ◽

Single Center Experience ◽

Estimated Blood Loss ◽

Chart Abstraction ◽

Feasible Alternative ◽

Median Operative Time

As bariatric surgery increases, there is a growing population of patients with biliary obstruction and anatomy which precludes transoral access through endoscopic retrograde cholangiopancreatography (ERCP). Minimally invasive transgastric ERCP (TG-ERCP) offers a feasible alternative for the treatment. A retrospective review was performed of all patients who underwent laparoscopic or robotic-assisted TG-ERCP between 2010 and 2017. Chart abstraction collected demographics, procedural details, success rate, and postoperative outcomes. Forty patients were identified, of which 38 cases were performed laparoscopically and two robotically. Median operative time was 163 minutes, with an estimated blood loss of 50 cc. TG-ERCP was performed successfully in 36 cases (90%); sphincterotomy was completed in 35 patients (97%). Sixty per cent already had a cholecystectomy; in the remaining patients, it was performed concurrently. Major complications included stomach perforation (n = 1), pancreatitis (n = 3), and anemia requiring transfusion (n = 2). In patients with biliary obstruction and anatomy not suitable for ERCP, TG-ERCP can be performed in a minimally invasive fashion, with a high rate of technical success and low morbidity. We describe a stepwise, reproducible technique because it is an essential tool for the shared armamentarium of endoscopists and surgeons.

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A team approach to anterior lumbar spine surgery in the military

Vascular ◽

10.1177/1708538113478757 ◽

2013 ◽

Vol 22 (4) ◽

pp. 246-251 ◽

Cited By ~ 3

Author(s):

Anahita Dua ◽

Jennifer Fox ◽

Bhavin Patel ◽

Eric Martin ◽

Michael Rosner ◽

...

Keyword(s):

Lumbar Spine ◽

Blood Loss ◽

Operative Time ◽

Lumbar Spine Surgery ◽

Team Approach ◽

Disc Space ◽

Estimated Blood Loss ◽

All Cause Mortality ◽

The Military ◽

Median Operative Time

We report a five year military experience with anterior retroperitoneal spine exposure combining vascular and neurosurgical spine teams. From August 2005 through April 2010 (56 months), hospital records from a single institution were retrospectively reviewed. Complications, estimated blood loss, transfusions, operative time and length of stay were documented. Eighty-four patients with lumbar spondylosis underwent primary (63, 75%) or secondary exposure (21, 25%) of a single- (66, 79%) or multilevel disc space (18, 21%). Median operative time and estimated blood loss were 127 minutes (range, 30–331 minutes) and 350 mL (range, 0–2940 mL). The overall complication rate was 23.8%. Postoperative complications included six blood transfusions (7%), three patients with retrograde ejaculation (3.57%) or surgical site infection; two with a prolonged ileus (2.38%) or ventral hernia and one each with a bowel obstruction (1, 1.19%), deep venous thrombosis or lymphocele. All-cause mortality was 1%. In conclusion, a team approach can minimize complications while offering the technical benefits and durability of an anterior approach to the lumbar spine.

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PS01.176: OPEN VERSUS HYBRID VERSUS MINIMALLY INVASIVE ESOPHAGECTOMY FOR PATIENTS WITH ESOPHAGEAL CANCER: A PROPENSITY SCORE MATCHED ANALYSIS

Diseases of the Esophagus ◽

10.1093/dote/doy089.ps01.176 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 99-100

Author(s):

Els Visser ◽

David Edholm ◽

Mark Smithers ◽

Janine Thomas ◽

Sandra Brosda ◽

...

Keyword(s):

Length Of Stay ◽

Minimally Invasive ◽

Survival Data ◽

Operative Time ◽

Conflicts Of Interest ◽

Minimally Invasive Esophagectomy ◽

Neoadjuvant Treatment ◽

Respiratory Complications ◽

Term Survival ◽

Invasive Esophagectomy

Abstract Background MIE is becoming more common and is considered safe. There are few studies supporting laparoscopy in favor of laparotomy for the abdominal part of a three-field esophagectomy and long term survival data are scarce. The objective was to compare open esophagectomy (OE), with hybdrid thoracoscopic-laparotomic esophagectomy (HMIE) and minimally invasive esophagectomy (MIE) with regard to surgical outcomes, postoperative complications and survival. Methods A prospective database of esophageal resection for cancer at a single centre identified 243 OE, 688 HMIE and 80 MIE procedures. Propensity scores were used to match 80 patients in each group adjusting for age, gender, weight, clinical stage, neoadjuvant treatment, and year of surgery. Results Respiratory complications were more common after OE (49%) than after MIE (31%, P = 0.02). Median operative time was longer for MIE (330 minutes) versus HMIE or OE (both 300 minutes, P < 0.001). Median length of stay was shorter following MIE (12 days) compared with HMIE (14 days) and OE (15 days), P = 0.001. There were no significant differences between groups with respect to other complications, median number of lymph nodes examined (22–23 for all groups), or R0 resection rate (range 85–91%) for all groups. There was no difference in 5-year overall survival between groups. Conclusion Compared with OE and HMIE, MIE was associated with shorter length of stay and fewer respiratory complications, but longer operative time. Thus, there may be additional benefit for MIE without comprising oncological outcomes. Disclosure All authors have declared no conflicts of interest.

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