Robotic-assisted minimally invasive esophagectomy: past, present and future

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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Linear stapled technique for robotic assisted minimally invasive esophagectomy

Annals of Esophagus ◽

10.21037/aoe-21-2 ◽

2021 ◽

Vol 0 ◽

pp. 0-0

Author(s):

Gijsbert I. van Boxel ◽

Nicholas C. Carter ◽

Benjamin C. Knight ◽

Veronika Fajksova ◽

Nicholas Jenkins ◽

...

Keyword(s):

Minimally Invasive ◽

Minimally Invasive Esophagectomy ◽

Robotic Assisted ◽

Invasive Esophagectomy

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Robotic assisted minimally invasive esophagectomy for esophageal cancer: a Comment on the Ruijin hospital experience

Journal of Thoracic Disease ◽

10.21037/jtd.2017.08.153 ◽

2017 ◽

Vol 9 (9) ◽

pp. 2888-2890

Author(s):

David Pennywell ◽

Inderpal S. Sarkaria

Keyword(s):

Esophageal Cancer ◽

Minimally Invasive ◽

Minimally Invasive Esophagectomy ◽

Robotic Assisted ◽

Invasive Esophagectomy ◽

Hospital Experience

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Redefining the learning curve for robotic esophagectomy.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.4_suppl.132 ◽

2018 ◽

Vol 36 (4_suppl) ◽

pp. 132-132

Author(s):

Ken Lee Meredith ◽

Jamie Huston ◽

Pedro Briceno ◽

Ravi Shridhar

Keyword(s):

Minimally Invasive ◽

Learning Curve ◽

Minimally Invasive Esophagectomy ◽

Neoadjuvant Chemoradiation ◽

Esophageal Disease ◽

Robotic Assisted ◽

Invasive Esophagectomy ◽

Robotic Esophagectomy ◽

Conversion Rates ◽

Morbidity Index

132 Background: Minimally invasive esophagectomy(MIE) has demonstrated superior outcomes compared to open approaches. The myriad of techniques has precluded the recommendation of a standard approach. The robotic approach has increased steadily. We have previously published our series defining the learning curve for this approach. The purpose of this study is to redefine the learning curve for robotic-assisted esophagogastrectomy with respect to operative time, conversion rates, and patient safety. Methods: We have prospectively followed all patients undergoing robotic-assisted esophagogastrectomy and compared operations performed at our institutions by a single surgeon in successive cohorts. Our measures of proficiency included: operative times, conversion rates, and complications. Statistical analyses were undertaken utilizing Spearman regression analysis and Mann-Whitney U test. Significance was accepted with 95 % confidence. Results: We identified 203 patients (166 [81.8%] male: 37 [18.2%] female) of median age of 67.2 (30-90) years who underwent robotic-assisted esophagogastrectomies for malignant esophageal disease. One-hundred sixty six were adenocarcinoma, 26 were squamous cell carcinoma and 11 were other. R0 resections was performed in 202 (99.5%) of patients. The median lymph node harvest was 18 (6-63). Neoadjuvant chemoradiation was administered to 157 (77.4%) patients. A significant reduction in operative times (p <0.005) following completion of 20 procedures was identified (514 ± 106 min vs. 415± 91 min compared to subsequent 80 cases and further reduced with the subsequent 100 cases 397 ± 71.9 min) p<0.001. Complications decreased after the initial learning curve of 29 cases, p=0.04. However there was an increase in complications after 90 cases in which there was an increase in the Charleson morbidity index, p<0.01 indicating higher risk patients which tapered after case 115. Conclusions: For surgeons proficient in performing minimally-invasive esophagogastrectomies, the learning curve for a robotic-assisted procedure appears to begin near proficiency after 20 cases however as more complex cases are undertake there appears to be an additional learning curve which is surpassed after 90 cases.

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End to side circular stapled anastomosis during robotic-assisted Ivor Lewis minimally invasive esophagectomy (RAMIE)

Diseases of the Esophagus ◽

10.1093/dote/doab088 ◽

2022 ◽

Author(s):

Giovanni Capovilla ◽

Edin Hadzijusufovic ◽

Evangelos Tagkalos ◽

Caterina Froiio ◽

Felix Berlth ◽

...

Keyword(s):

Esophageal Cancer ◽

Minimally Invasive ◽

Primary Outcome ◽

Minimally Invasive Esophagectomy ◽

Postoperative Mortality ◽

The Other ◽

Ivor Lewis ◽

Robotic Assisted ◽

Intrathoracic Anastomosis ◽

Invasive Esophagectomy

Abstract Robotic-assisted minimally invasive esophagectomy (RAMIE) represents an established approach for the treatment of esophageal cancer. Aim of this study is to evaluate the feasibility and safety of our technique for performing the intrathoracic anastomosis during RAMIE.All the procedures were performed by the same surgeon using the same technique for performing the intrathoracic anastomosis. Intraoperative and postoperative outcomes were recorded. Postoperative complications were classified according to the Esophagectomy Complications Consensus Group (ECCG); the primary outcome was the evaluation of the feasibility and safety of our technique. From 2016 to 2021, 204 patients underwent Ivor Lewis RAMIE at our Center. Two patients (0.9%) were converted during the thoracic phase. The anastomosis was completed in all the other patients forming complete anastomotic rings. The median duration for the robotic-assisted thoracoscopic phase was 224 minutes. Twenty-two of the RAMIE-Ivor Lewis patients had an anastomotic leakage (10.3%). The overall 90-day postoperative mortality was 1.9%. The procedure resulted to be feasible and safe in our cohort of patients.

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