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Contribution of robotics to minimally invasive esophagectomy

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Abstract

Robot-assisted surgery has the advantages of a three-dimensional view, versatility of instruments and better ergonomics. It allows fine dissection and difficult anastomoses in deep fields. Based on our experience, we try to define what are the main contributions of robotics to minimally invasive esophagectomy. From December 2009 to July 2012, we performed 24 minimally invasive esophagectomies (9 transhiatal, 5 Ivor-Lewis and 10 three-field), 16 of them robotically (8, 5 and 3, respectively). Eighteen patients (18/24 = 75 %) received neoadjuvant therapy. Nine patients (9/24 = 37.5 %) had symptomatic complications: 4 anastomotic leaks treated conservatively, one staple failure of the gastric plasty needing reoperation, one biliary peritonitis secondary to a gangrenous cholecystitis, one intrathoracic gastric migration after the only nonresectable case, one chylothorax and one patient with major cardiopulmonary complications. The median number of lymph nodes harvested was 12 ± 7. Median length of stay was 14 ± 13.5 days. Thirty-day mortality was nil. Complications were not related to the robot itself but to the complexity of both the technique and the patient. Although we found no advantages for the use of robotics during threefield minimally invasive esophagectomy, robotic mediastinal dissection during transhiatal esophagectomy can be performed safely under direct vision. Moreover, hand-sewn robotic-assisted technique in the prone position is promising and maybe the simplest way to carry out thoracic anastomosis during Ivor-Lewis esophagectomy

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References

  1. Schuchert MJ, Luketich JD, Landreneau RJ (2010) Management of esophageal cancer. Curr Probl Surg 47:845–946

    Article  PubMed  Google Scholar 

  2. Nagpal K, Ahmed K, Vats A, Yakoub D, James D, Ashrafian H, Darzi A, Moorthy K, Athanasiou T (2010) Is minimally invasive surgery beneficial in the management of esophageal cancer? A meta-analysis. Surg Endosc 24:1621–1629

    Article  Google Scholar 

  3. Herron DM, Marohn M and The SAGES-MIRA Robotic Surgery Consensus Group (2008) A consensus document on robotic surgery. Surg Endosc 22:313–325

    Google Scholar 

  4. Kim DJ, Hyung WJ, Lee CY, Lee JG, Haam SJ, Park IK, Chung KY (2010) Thoracoscopic esophagectomy for esophageal cancer: feasibility and safety of robotic assistance in the prone position. J Thorac Cardiovasc Surg 139:53–59

    Google Scholar 

  5. Pennathur A, Zhang J, Chen H, Luketich JD (2010) The “best operation” for esophageal cancer? Ann Thorac Surg 89:S2163–S2167

    Google Scholar 

  6. Tsai WS, Levy RM, Luketich JD (2009) Technique of minimally invasive Ivor Lewis esophagectomy. Oper Techn Thorac Cardiovasc Surg 14:176–192

    Google Scholar 

  7. Campos GM, Jablons D, Brown LM, Ramirez RM, Rabl C, Theodore P (2010) A safe and reproducible anastomotic technique for minimally invasive Ivor Lewis oesophagectomy: the circular-stapled anastomosis with the trans-oral anvil. Eur J Cardiothorac Surg 37:1421–1426

    Google Scholar 

  8. Nguyen NT, Hinojosa MW, Smith BR, Gray J, Reavis KM (2008) Thoracoscopic construction of an intrathoracic esophagogastric anastomosis using a circular stapler: transoral placement of the anvil. Ann Thorac Surg 86:989–993

    Article  Google Scholar 

  9. Blackmon SH, Correa AM, Wynn B, Hofstetter WL, Martin LW, Mehran RJ, Rice DC, Swisher SG, Walsh GL, Roth JA, Vaporciyan AA (2007) Propensity-matched analysis of three techniques for intrathoracic esophagogastric anastomosis. Ann Thorac Surg 83:1805–1813

    Article  Google Scholar 

  10. Barkun JS, Aronson JK, Feldman LS, Maddern GJ, Strasberg SM (2009) Evaluation and stages of surgical innovations,for the Balliol Collaboration. Lancet 374:1089–1096

    Article  Google Scholar 

  11. McCulloch P, Altman DG, Campbell WB, Flum DR, Glasziou P, Marshall JC, Nicholl J (2009) No surgical innovation without evaluation: the IDEAL recommendations, for the Balliol Collaboration. Lancet 374:1105–1112

    Article  Google Scholar 

  12. Schuchert MJ, Pettiford BL, Landreneau JP, Waxman J, Kilic A, Santos RS, Kent MS, El-Sherif A, Abbas G, Luketich JD, Landreneau RJ (2008) Transcervical gastric tube drainage facilitates patient mobility and reduces the risk of pulmonary complications after esophagectomy. J Gastrointest Surg 12:1479–1484

    Article  Google Scholar 

  13. Loureiro Gonzalez C, Diez del Val I, Gonzalez Serrano C, Bilbao Axpe JE (2011) Imagen del mes: herniación postoperatoria del estómago hacia cavidad pleural. Cir Esp 89:e11

    Article  PubMed  Google Scholar 

  14. Bakhos CT, Fabian T, Oyasiji TO, Gautam S, Gangadharan SP, Kent MS, Martin J, Critchlow JF, De Camp MM (2012) Impact of the surgical technique on pulmonary morbidity after esophagectomy. Ann Thorac Surg 93:221–227

    Article  Google Scholar 

  15. Biere SSAY, van Berge Henegouwen MI, Maas KW, Bonavina L, Rosman C, Roig Garcia J, Gisbertz SS, Klinkenbijl JHG, Hollmann MW, de Lange ESM, Bonjer HJ, van der Peet DL, Cuesta MA (2012) Minimally invasive versus open oesophagectomy for patients with oesophageal cancer: a multicentre, open-label, randomised controlled trial. Lancet 379:1887–1892

    Article  Google Scholar 

  16. Javidfar J, Bacchetta M, Yang JA, Miller J, D’Ovidio F, Ginsburg ME, Gorenstein LA, Bessler M, Sonett JR (2012) The use of a tailored surgical technique for minimally invasive esophagectomy. J Thorac Cardiovasc Surg 143:1125–1129

    Google Scholar 

  17. Sgourakis G, Gockel I, Radtke A, Musholt TJ, Timm S, Rink A, Tsiamis A, Karaliotas C, Lang H (2010) Minimally invasive versus open esophagectomy: meta-analysis of outcomes. Dig Dis Sci 55:3031–3040

    Article  Google Scholar 

  18. Schoppmann SF, Prager G, Langer FB, Riegler FM, Kabon B, Fleischmann E, Zacherl J (2010) Open versus minimally invasive esophagectomy: a single-center case controlled study. Surg Endosc 24:3044–3053

    Article  Google Scholar 

  19. Gemmill EH, McCulloch P (2007) Systematic review of minimally invasive resection for gastro-oesophageal cancer. Br J Surg 94:1461–1467

    Article  Google Scholar 

  20. Urschel JD, Blewett CJ, Bennett WF, Miller JD, Young JEM (2001) Handsewn or stapled esophagogastric anastomoses after esophagectomy for cancer: meta-analysis of randomized controlled trials. Dis Esoph 14:212–217

    Article  Google Scholar 

  21. Kim RH, Takabe K (2010) Methods of esophagogastric anastomoses following esophagectomy for cancer: a systematic review. J Surg Oncol 101:527–533

    Google Scholar 

  22. Honda M, Kuriyama A, Noma H, Nunobe S, Furukawa TA (2012) Hand-sewn versus mechanical esophagogastric anastomosis after esophagectomy. A systematic review and meta-analysis. Ann Surg (online first). doi:10.1097/SLA.0b013e31826d4723

    Google Scholar 

  23. Cassivi SD (2004) Leaks, strictures and necrosis: a review of anastomotic complications following esophagectomy. Sem Thorac Cardiovasc Surg 16:124–132

    Article  Google Scholar 

  24. Hoppo T, Jobe BA, Hunter JG (2011) Minimally invasive esophagectomy: the evolution and technique of minimally invasive surgery for esophageal cancer. World J Surg 35:1454–1463

    Article  Google Scholar 

  25. Butler N, Collins S, Memon B, Memon MA (2011) Minimally invasive oesophagectomy: current status and future direction. Surg Endosc 25:2071–2083

    Article  Google Scholar 

  26. Boshier PR, Anderson O, Hanna GB (2011) Transthoracic versus transhiatal esophagectomy for the treatment of esophagogastric cancer. A meta-analysis. Ann Surg 254:894–906

    Article  Google Scholar 

  27. Pennathur A, Awais O, Luketich JD (2010) Technique of minimally invasive Ivor Lewis esophagectomy. Ann Thorac Surg 89:S262–S2159

    Google Scholar 

  28. Cuesta MA, Scheepers JJG, Oosterhuis W, Biere SSAY, van der Peet DL, Heijnen BHM (2010) Thoracoscopic esophageal resection for cancer in prone decubitus position: operative technique. In: Puntambekar S, Cuesta MA (eds) Atlas of minimally invasive surgery in esophageal carcinoma. Springer Science, New York, pp 149–170

    Google Scholar 

  29. Watson DI, Davies N, Jamieson GG (1999) Totally endoscopic Ivor Lewis esophagectomy. Surg Endosc 13:293–297

    Google Scholar 

  30. Cadière GB, Dapri G, Himpens J, Fodderie L, Rajan A (2010) Ivor Lewis esophagectomy with manual esogastric anastomosis by thoracoscopy in prone position and laparoscopy. Surg Endosc 24:1482–1485

    Article  Google Scholar 

  31. Kernstine KH, DeArmond DT, Shamoun DM, Campos JH (2007) The first series of completely robotic esophagectomies with three-field lymphadenectomy: initial experience. Surg Endosc 21:2285–2292

    Article  Google Scholar 

  32. Galvani CA, Gorodner MV, Moser F, Jacobsen G, Chretien C, Espat NJ, Donahue P, Horgan S (2008) Robotically assisted laparoscopic transhiatal esophagectomy. Surg Endosc 22:188–195

    Article  Google Scholar 

  33. Gutt CN, Bintintan VV, Köninger J, Müller-Stich BP, Reiter M, Büchler MW (2006) Robotic-assisted transhiatal esophagectomy. Langenbecks Arch Surg 391:428–434

    Article  Google Scholar 

  34. Clark J, Sodergren MH, Purkayastha S, Mayer EK, James D, Athanasiou T, Yang GZ, Darzi A (2011) The role of robotic assisted laparoscopy for oesophagogastric oncological resection; an appraisal of the literature. Dis Esoph 24:240–250

    Article  Google Scholar 

  35. Boone J, Schipper MEI, Moojen WA, Borel Rinkes IHM, Cromheecke GJE, van Hillegersberg R (2009) Robot-assisted thoracoscopic oesophagectomy for cancer. Br J Surg 96:878–886

    Article  Google Scholar 

  36. Huettner F, Dynda D, Ryan M, Doubet J, Crawford DL (2010) Robotic-assisted minimally invasive surgery; a useful tool in resident training—the Peoria experience, 2002–2009. Int J Med Robotics Comput Assist Surg 6:386–393

    Article  Google Scholar 

  37. Watson TJ (2008) Robotic esophagectomy: is it an advance and what is the future? Ann Thorac Surg 85:757–759

    Article  Google Scholar 

Download references

Acknowledgments

We have to thank Dr. Peter McCulloch, from the center for evidence-based medicine (Oxford, UK), for his critical review of the manuscript.

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Authors and Affiliations

  1. Esophago-gastric Surgery and Robotic Unit, Service of General and Digestive Surgery, Basurto University Hospital, Avenida Montevideo, 18, 48013, Bilbao, Spain

    Ismael Diez Del Val, Carlos Loureiro Gonzalez, Julen Barrenetxea Asua & Jose Esteban Bilbao Axpe

  2. Esophago-gastric Surgery Unit, Service of General and Digestive Surgery, Donostia University Hospital, Paseo Dr Begiristain, 115, 20080, san sebastian, Spain

    Santiago Larburu Etxaniz

  3. Service of General and Digestive Surgery, Basurto University Hospital, Avenida Montevideo, 18, 48013, Bilbao, Spain

    Saioa Leturio Fernandez, Sandra Ruiz Carballo, Eider Etxebarria Beitia, Patricia Perez de Villarreal, Lorena Hierro-Olabarria & Jaime Jesus Mendez Martin

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  1. Ismael Diez Del Val
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  2. Carlos Loureiro Gonzalez
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  3. Santiago Larburu Etxaniz
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Correspondence to Ismael Diez Del Val.

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Diez Del Val, I., Loureiro Gonzalez, C., Larburu Etxaniz, S. et al. Contribution of robotics to minimally invasive esophagectomy. J Robotic Surg 7, 325–332 (2013). https://doi.org/10.1007/s11701-012-0391-y

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