Robot-assisted gastroesophageal surgery: usefulness and limitations

Abstract

Robot-assisted surgery overcomes some of the limitations of traditional laparoscopic surgery. We present our experience and lessons learned in two surgical units dedicated to gastro-esophageal surgery. From June 2009 to January 2013, we performed 130 robot-assisted gastroesophageal procedures, including Nissen fundoplication (29), paraesophageal hernia repair (18), redo for failed antireflux surgery (11), esophagectomy (19), subtotal (5) or wedge (4) gastrectomy, Heller myotomy for achalasia (22), gastric bypass for morbid obesity (12), thoracoscopic leiomyomectomy (4), Morgagni hernia repair (3), lower-third esophageal diverticulectomy (1) and two diagnostic procedures. There were 80 men and 50 women with a median age of 54 years (interquartile range: 46-65). Ten patients (7.7 %) had severe postoperative complications: eight after esophagectomy (three leaks-two cervical and one thoracic-managed conservatively), one stapler failure, one chylothorax, one case of gastric migration to the thorax, one case of biliary peritonitis, and one patient with a transient ventricular dyskinesia. One redo procedure needed reoperation because of port-site bleeding, and one patient died of pulmonary complications after a giant paraesophageal hernia repair; 30-day mortality was, therefore, 0.8 %. There were six elective and one forced conversions (hemorrhage), so total conversion was 5.4 %. Median length of stay was 4 days (IQ range 3-7). Robot-assisted gastroesophageal surgery is feasible and safe, and may be applied to most common procedures. It seems of particular value for Heller myotomy, large paraesophageal hernias, redo antireflux surgery, transhiatal dissection, and hand-sewn intrathoracic anastomosis.

Intrathoracic side‐to‐side esophagogastrostomy with a linear stapler and barbed suture in robot‐assisted Ivor Lewis esophagectomy

“…The robotic system can offer high‐definition 3‐d vision, tremor filtration and a 7‐degree articulation of the instruments, which appears useful for precise manifestation in tiny spaces . Taking advantage of these features, surgical robots seems to become the preferred surgical instrument in esophagogastric anastomosis by the means of hand‐sewn, circular stapled, or linear stapled approaches …”

Long Term Outcomes of Surgical and Clinical Symptoms Following Minimally Invasive Heller Myotomy: A Retrospective Clinical Database Review

“…23 Mortality rates following perforation have been reported to be as high as 40%. [24][25][26][27] The low rate of perforations in our cohort, coupled with a significant improvement in esophageal symptom scores, supports that MIHM is a safe and efficacious treatment for achalasia. An important marker of success following surgical treatment of achalasia is the resolution of dysphagia and other esophageal symptoms.…”

The ALBS (Albert-Lembert with Knotless Barbed Sutures) Method for Esophagojejunostomy After Totally Robotic Radical Total Gastrectomy

“…It also provides intuitive motion of the surgical instrumentation and tremor reduction with motion scaling. 1 These unique advantages make hand-sewn esophagojejunostomy easier and more feasible. Therefore, our center applied the Albert-Lembert with knotless barbed sutures (ALBS) method for esophagojejunostomy during totally robotic total radical gastrectomy.…”