Robot‐assisted minimally invasive esophagectomy for esophageal cancer: Meticulous surgery minimizing postoperative complications

Abstract

Minimally invasive esophagectomy (MIE) has been reported to reduce postoperative complications especially pulmonary complications and have equivalent long‐term survival outcomes as compared to open esophagectomy. Robot‐assisted minimally invasive esophagectomy (RAMIE) using da Vinci surgical system (Intuitive Surgical, Sunnyvale, USA) is rapidly gaining attention because it helps surgeons to perform meticulous surgical procedures. McKeown RAMIE has been preferably performed in East Asia where squamous cell carcinoma which lies in more proximal esophagus than adenocarcinoma is a predominant histological type of esophageal cancer. On the other hand, Ivor Lewis RAMIE has been preferably performed in the Western countries where adenocarcinoma including Barrett esophageal cancer is the most frequent histology. Average rates of postoperative complications have been reported to be lower in Ivor Lewis RAMIE than those in McKeown RAMIE. Ivor Lewis RAMIE may get more attention for thoracic esophageal cancer. The studies comparing RAMIE and MIE where recurrent nerve lymphadenectomy was thoroughly performed reported that the rate of recurrent nerve injury is lower in RAMIE than in MIE. Recurrent nerve injury leads to serious complications such as aspiration pneumonia. It seems highly probable that RAMIE is beneficial in performing recurrent nerve lymphadenectomy. Surgery for esophageal cancer will probably be more centralized in hospitals with surgical robots, which enable accurate lymph node dissection with less complications, leading to improved outcomes for patients with esophageal cancer. RAMIE might occupy an important position in surgery for esophageal cancer.

Robot-assisted esophagectomy with robot-sewn intrathoracic anastomosis (Ivor Lewis): surgical technique and early results

“…In this study, robot-sewn anastomosis provided an anastomotic leak rate of 3.3% ( n = 1, ECCG, Type III). This finding is consistent with that reported by other similar studies ranging from 0 to 32% (Table 4 ) and with the average anastomotic insufficiency rate (up to 5.6%) reported by other experiences of Ivor Lewis RAMIE with mechanical intrathoracic anastomosis [ 8 ]. Of note is the fact that the ICAN randomized controlled study (in agreement with other not randomized studies [ 28 – 30 ]) has recently shown that in the setting of a MI approach, intrathoracic anastomosis is associated with a clinically relevant lower leakage rate compared to cervical anastomosis.…”

“…The creation of an intrathoracic anastomosis is considered quite challenging even during MIE owing to the intrinsic limitations of this technique and so far, no general consensus exists on the optimal anastomosis [ 7 ]. Recently, a robotic approach has been implemented to facilitate complex minimally invasive (MI) procedures by combining the optimal advantage of its ergonomics [ 8 ]. This technology might be particularly useful for the thoracic stage of Ivor Lewis en-bloc esophagectomy (ILE), especially when a hand-sewn esophagogastrostomy is planned.…”

Anatomical factor associated with thoracic procedural difficulty in robot-assisted minimally invasive esophagectomy

“…Robotic surgical systems with full articulation of instruments, tremor ltering, and motion scaling can potentially overcome the procedural di culties in endoscopic surgery [7]. However, we still encounter challenging cases of RAMIE in clinical settings.…”

Anatomical factor associated with thoracic procedural difficulty in robot-assisted minimally invasive esophagectomy

“…Since then, the RAMIE has spread rapidly. Robotic surgical systems with full articulation of instruments, tremor ltering, and motion scaling can potentially overcome the procedural di culties in endoscopic surgery [7]. However, we still encounter challenging cases of RAMIE in clinical settings.…”