Abstract
Background
Difficulties in thoracic access and the risk of pulmonary complications are major problems in esophageal surgery. Transhiatal techniques have been described to avoid the thoracic approach, but their oncological radicality continues to be questioned. A combination of a cervical and transhiatal approach, however, appears promising. We describe the technique of a robot-assisted cervical esophagectomy (RACE procedure), combined with a transhiatal approach in a rendezvous technique.
Methods
The da Vinci Xi® robotic system was docked in a single port technique via a cervical approach. The upper third of the esophagus and the surrounding lymphatic tissue was dissected thoracically. Subsequently, the system was docked abdominally to allow us to completely dissect the esophagus in the rendezvous procedure.
Results
The patients (n = 4) suffered no trauma or injury to surrounding structures during the procedure, and sensitive structures were preserved. Almost no robot arm collision occurred, and the arms did not contact the patients’ head or shoulders. No patient converted to conventional robotic-assisted transthoracic esophagectomy. Complications included anastomotic leakage (n = 1), transient palsy of the recurrent laryngeal nerve (n = 1), and pneumonia (n = 1).
Conclusions
The cervical approach to esophagectomy allows comfortable preparation and facilitates transhiatal access, while the rendezvous procedure enables easy identification of the cranial dissection plane. The degrees of freedom of movement of the robotic instruments allow for precise and controlled preparation, and the latest technology minimizes the risk of robot arm collision in single-excision surgery. This combined, robot-assisted approach appears to be a promising procedure for esophagectomy.
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Acknowledgements
Thanks are given to Deborah Nock (Medical WriteAway, Norwich, UK) for editorial assistance.
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Jan-Hendrik Egberts and Jan-Hendrik Beckmann are paid by Intuitive Surgery for proctoring surgical teams. Thomas Becker received a research grant by Intuitive SurgeryTM. The other authors have no conflicts of interest to declare.
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Abdominal phase: Transhiatal dissection of the esophagus und gastrolysis with DII lymphadenectomy (MP4 471,048 kb)
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Egberts, JH., Schlemminger, M., Hauser, C. et al. Robot-assisted cervical esophagectomy (RACE procedure) using a single port combined with a transhiatal approach in a rendezvous technique: a case series. Langenbecks Arch Surg 404, 353–358 (2019). https://doi.org/10.1007/s00423-019-01785-y
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DOI: https://doi.org/10.1007/s00423-019-01785-y