Abstract
Background
Esophagectomy is a technically demanding operation with high procedure-related morbidity and mortality rates. Minimally invasive techniques were introduced in the late 1980s in an effort to decrease the invasiveness of the procedure. Data concerning the use of robotic systems for esophageal cancer are scarce in the literature. The goal of this report is to describe the authors’ early experience using robotically assisted technology to perform transhiatal esophagectomy (RATE).
Methods
Between September 2001 and May 2004, 18 patients underwent RATE at the authors’ institution. A retrospective review of prospectively collected data was performed. Gender, age, postoperative diagnosis, operative time, conversion rate, blood loss, hospital stay, length of the follow-up period, and complications were assessed.
Results
At the authors’ institution, 18 patients underwent RATE, including 16 men (89%), with a mean age of 54 years (range, 41–73 years). The RATE procedure was completed for all 18 patients (100%). The mean operative time was 267 ± 71 min, and estimated blood loss was 54 ml (range, 10–150 ml). The mean intensive care unit stay was 1.8 days (range, 1–5 days), and the mean hospital stay was 10 days (range, 4–38 days). A total of 12 perioperative complications occurred for 9 patients, including 6 anastomotic leaks, 1 thoracic duct injury, 1 vocal cord paralysis, 1 pleural effusion, and 2 atrial fibrillations. Anastomotic stricture was observed in six patients. There were no perioperative deaths. Pathologic examination of the surgical specimen yielded an average of 14 lymph nodes per patient (range, 7–27). During the mean follow-up period of 22 ± 8 months, 2 patients died, 2 were lost to follow-up evaluation, 3 had recurrence, and 11 were disease free.
Conclusion
The current study shows that RATE, with its decreased blood loss, minimal cardiopulmonary complications, and no hospital mortality, represents a safe and effective alternative for the treatment of esophageal adenocarcinoma.
Similar content being viewed by others
References
Bodner J, Wykypiel H, Wetscher G, Schmid T (2004) First experiences with the da Vinci operating robot in thoracic surgery. Eur J Cardiothorac Surg 25:844–851
Cadiere GB, Himpens J, Germay O, Izizaw R, Degueldre M, Vandromme J, Capelluto E, Bruyns J (2001) Feasibility of robotic laparoscopic surgery: 146 cases. World J Surg 25:1467–1477
Chu KM, Law SY, Fok M, Wong JA (1997) Prospective randomized comparison of transhiatal and transthoracic resection for lower-third esophageal carcinoma. Am J Surg 174:320–324
Cuschieri A, Shimi S, Banting S (1992) Endoscopic oesophagectomy through a right thoracoscopic approach. J R Coll Surg Edinb 37:7–11
De Paula AL, Hashiba K, Ferreira EA, de Paula RA, Grecco E (1995) Laparoscopic transhiatal esophagectomy with esophagogastroplasty. Surg Laparosc Endosc 5:1–5
Espat NJ, Jacobsen G, Horgan S, Donahue P (2005) Minimally invasive treatment of esophageal cancer: laparoscopic staging to robotic esophagectomy. Cancer J 11:10–17
Gossot D, Cattan P, Fritsch S, Halimi B, Sarfati E, Celerier M (1995) Can the morbidity of esophagectomy be reduced by the thoracoscopic approach? Surg Endosc 9:1113–1115
Horgan S, Knoblock L (2003) Esophageal surgery applications. In: Scott Melvin W, Nathaniel J. Soper (eds) Problems in general surgery. Robotics in general surgery, vol 20. Lippincott Williams & Wilkins, Inc., Philadelphia, pp 31–37
Horgan S, Berger RA, Elli EF, Espat NJ (2003) Robotic-assisted minimally invasive transhiatal esophagectomy. Am Surg 69:624–626
Jacobsen G, Elli F, Horgan S (2004) Robotic surgery update. Surg Endosc 18:1186–1191
Kawahara K, Maekawa T, Okabayashi K, Hideshima T, Shiraishi T, Yoshinaga Y, Shirakusa T (1999) Video-assisted thoracoscopic esophagectomy for esophageal cancer. Surg Endosc 13:218–223
Law S, Wong J (2002) Use of minimally invasive oesophagectomy for cancer of the oesophagus. Lancet Oncol 3:215–222
Law S, Fok M, Chu KM, Wong J (1997) Thoracoscopic esophagectomy for esophageal cancer. Surgery 122:8–14
Luketich JD, Schauer PR, Christie NA, Weigel TL, Raja S, Fernando HC, Keenan RJ, Nguyen NT (2000) Minimally invasive esophagectomy. Ann Thorac Surg 70:906–911, discussion 911–902
Luketich JD, Alvelo-Rivera M, Buenaventura PO, Christie NA, McCaughan JS, Litle VR, Schauer PR, Close JM, Fernando HC (2003) Minimally invasive esophagectomy: outcomes in 222 patients. Ann Surg 238:486–494, discussion 494–485
McAnena OJ, Rogers J, Williams NS (1994) Right thoracoscopically assisted oesophagectomy for cancer. Br J Surg 81:236–238
Moorthy K, Munz Y, Dosis A, Hernandez J, Martin S, Bello F, Rockall T, Darzi A (2004) Dexterity enhancement with robotic surgery. Surg Endosc 18(5):790–795
Nguyen NT, Roberts P, Follette DM, Rivers R, Wolfe BM (2003) Thoracoscopic and laparoscopic esophagectomy for benign and malignant disease: lessons learned from 46 consecutive procedures. J Am Coll Surg 197:902–913
Nguyen NT, Follette DM, Wolfe BM, Schneider PD, Roberts P, Goodnight JE Jr (2000) Comparison of minimally invasive esophagectomy with transthoracic and transhiatal esophagectomy. Arch Surg 135:920–925
Oelschlager BK, Pellegrini CA (2001) Role of laparoscopy and thoracoscopy in the treatment of esophageal adenocarcinoma. Dis Esophagus 14:91–94
Okushiba S, Ohno K, Itoh K, Ohkashiwa H, Omi M, Satou K, Kawarada Y, Morikawa T, Kondo S, Katoh H (2003) Hand-assisted endoscopic esophagectomy for esophageal cancer. Surg Today 33:158–161
Orringer MB, Marshall B, Iannettoni MD (1999) Transhiatal esophagectomy: clinical experience and refinements. Ann Surg 230:392–400, discussion 400–393
Patti MG, Corvera CU, Glasgow RE, Way LW (1998) A hospital’s annual rate of esophagectomy influences the operative mortality rate. J Gastrointest Surg 2:186–192
Peracchia A, Rosati R, Fumagalli U, Bona S, Chella B (1997) Thoracoscopic dissection of the esophagus for cancer. Int Surg 82:1–4
Swanstrom LL, Hansen P (1997) Laparoscopic total esophagectomy. Arch Surg 132:943–947, discussion 947–949
Urschel JD (1995) Esophagogastrostomy anastomotic leaks complicating esophagectomy: a review. Am J Surg 169:34–640
Yamamoto S, Kawahara K, Maekawa T, Shiraishi T, Shirakusa T (2005) Minimally invasive esophagectomy for stage I and II esophageal cancer. Ann Thorac Surg 80:2070–2075
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Galvani, C.A., Gorodner, M.V., Moser, F. et al. Robotically assisted laparoscopic transhiatal esophagectomy. Surg Endosc 22, 188–195 (2008). https://doi.org/10.1007/s00464-007-9441-3
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00464-007-9441-3