Robot-Assisted Minimally Invasive Ivor Lewis Esophagectomy With Real-Time Perfusion Assessment

Hodari, Arielle; Park, Ko Un; Lace, Brian; Tsiouris, Athanasios; Hammoud, Zane T.

doi:10.1016/j.athoracsur.2015.03.084

Cited by 51 publications

(34 citation statements)

References 27 publications

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“…However, its utilization in thoracic surgery is still preliminary because the detection system has not been developed into clinical size until recently. Some reports have applied NIR thoracoscopy with ICG to identify segmental fissure in video-assisted thoracoscopic segmentectomy (7) and to evaluate the blood supply of gastric conduit in robot-assisted minimally invasive Ivor Lewis esophagectomy (8). In order to get the fluorescent imaging in this study, we illuminate the tissue of interest with light at the excitation wavelength (about 750 to 800 nm) while observing it at longer emission wavelengths (over 800 nm).…”

Section: Discussionmentioning

confidence: 99%

Clinical application of near-infrared thoracoscope with indocyanine green in video-assisted thoracoscopic bullectomy

Li¹,

Zhou²,

Chi

et al. 2016

J. Thorac. Dis.

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Failure to identify all the possible bullous lesions was considered an important reason for the higher recurrence rate after the VATS bullectomy. We applied the latest near-infrared (NIR) thoracoscope with indocyanine green (ICG) to detect bullous lesions for patients with spontaneous pneumothorax. Two male patients with spontaneous pneumothorax and poorly identified bullae intraoperatively were included in this pilot study. An NIR thoracoscope with two different doses of ICG injection (0.2 and 0.6 mg/kg) was used to detect bullous lesions during VATS bullectomy. Partial lung resections of the bullous lesions were performed under syncretic mode. Data was managed with ImageJ software. No procedure-related complications were observed. The fluorescent signal was detected in normal lung tissue 10.5 seconds (mean, 10-11 seconds) after the ICG bolus, and lasted up to 525 seconds (mean, 480-570 seconds). The bullous lesions showed an obviously decreased fluorescent densities comparing to adjacent normal tissue.At the dosage of 0.6 mg/kg, ICG emits sufficient fluorescence to demonstrate the precise border of bullae, with the max SBR of 6.32. All resected specimens were confirmed as bullous lesions microscopically. NIR thoracoscope with intravenous ICG is a safe, accurate and real-time method to detect bullous lesions of lung tissue difficult to be found under normal light in human subjects. (Figure 1).Two different modes for demonstration are used intraoperatively. In fluorescent mode, the emitting density of NIR light from ICG molecule is captured by the NIR charge coupled device (CCD) matrix and display as black and white signal on the monitor screen. In syncretic mode, further after effects are utilized. First, the original density of NIR signal is interpreted according to green color gradation. Then, the images from NIR CCD and white light CCD are synchronized and fused into one image, so that the two different spectrums can be observed simultaneously.Patients with spontaneous pneumothorax and poorly identified bullae intraoperatively both under normal light and with air recruitment were included. Eventually, two male patients with spontaneous pneumothorax were enrolled. Both patients were confirmed to have no drug allergy to iodine or ICG. The mean age of the patients was 25.5 years (mean, 22-29 years). The study was approved by the Institutional Review Board of Peking University People's Hospital (IRB No. 2015PHB157-01) and registered at ClinicalTrials.gov (ID: NCT02611245). Written informed consent was signed by both patients.After general anesthesia, VATS bullectomy was performed. Both patients underwent thoracoscopic explorations under normal white light and then with air recruitment before ICG injection. NIR mode was used to observe the fluorescent status of the lung after the injection of different doses of ICG. Following procedures were operated under syncretic mode. Surgical specimens were submitted for pathologic examination ( Figure 2).Image analysis software (ImageJ v1.44) was used to quanti...

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Section: Discussionmentioning

confidence: 99%

Clinical application of near-infrared thoracoscope with indocyanine green in video-assisted thoracoscopic bullectomy

Li¹,

Zhou²,

Chi

et al. 2016

J. Thorac. Dis.

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“…Indications for robotic TTE are similar to those for conventional procedures, and tumor locations were mostly the middle esophagus, the lower esophagus, or the gastroesophageal junctions 29, 30, 31, 32. A potential advantage of real‐time perfusion assessment using indocyanine green and software built into the robotic console was recently reported:38 prevention of anastomotic leakage with allegedly easier detection of poorly perfused tissues at the anastomotic site.…”

Section: After the Initial Seriesmentioning

confidence: 99%

Robotic surgery for esophageal cancer: Merits and demerits

Seto

Mori

Aikou

2017

Annals of Gastroent Surgery

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Since the introduction of robotic systems in esophageal surgery in 2000, the number of robotic esophagectomies has been gradually increasing worldwide, although robot‐assisted surgery is not yet regarded as standard treatment for esophageal cancer, because of its high cost and the paucity of high‐level evidence. In 2016, more than 1800 cases were operated with robot assistance. Early results with small series demonstrated feasibility and safety in both robotic transhiatal (THE) and transthoracic esophagectomies (TTE). Some studies report that the learning curve is approximately 20 cases. Following the initial series, operative results of robotic TTE have shown a tendency to improve, and oncological long‐term results are reported to be effective and acceptable: R0 resection approaches 95%, and locoregional recurrence is rare. Several recent studies have demonstrated advantages of robotic esophagectomy in lymphadenectomy compared with the thoracoscopic approach. Such technical innovations as three‐dimensional view, articulated instruments with seven degrees of movement, tremor filter etc. have the potential to outperform any conventional procedures. With the aim of preventing postoperative pulmonary complications without diminishing lymphadenectomy performance, a nontransthoracic radical esophagectomy procedure combining a video‐assisted cervical approach for the upper mediastinum and a robot‐assisted transhiatal approach for the middle and lower mediastinum, transmediastinal esophagectomy, was developed; its short‐term outcomes are promising.Thus, the merits or demerits of robotic surgery in this field remain quite difficult to assess. However, in the near future, the merits will definitely outweigh the demerits because the esophagus is an ideal organ for a robotic approach.

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“…In RAMIE, most systems routinely have a real-time perfusion assessment system using diluted indocyanine green, and Hodari et al [60] reported a low anastomotic leak rate of 6.8% using this system in a cohort of 54 patients. While RATE itself was not further pursued, interesting developments have been reported using a cervical robotic access for upper mediastinal dissection.…”

Section: Special Developments In Robotic-assisted Esophageal Resectionmentioning

confidence: 99%

Upper Gastrointestinal Surgery: Robotic Surgery versus Laparoscopic Procedures for Esophageal Malignancy

Biebl¹,

Ανδρέου²,

Chopra³

et al. 2018

Visc Med

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Background: The evolution of minimally invasive surgery (MIS) also extends to the field of esophageal surgery and has brought forth the development of several approaches of minimally invasive esophagectomy (MIE). Hybrid and total minimally invasive operative techniques have proven beneficial compared to open surgery and are currently evaluated against robotic-assisted minimally invasive esophagectomy (RAMIE). We aim to review the current literature regarding the position of MIE versus RAMIE. Methods: A systematic review of the relevant literature on minimally invasive esophageal surgery for cancer is presented. A PubMed search was carried out for the period of 1992-2018 with the following search terms: ‘esophageal cancer', ‘minimally invasive surgery', ‘resection', ‘transhiatal', ‘transthoracic', ‘MIE', ‘hybrid', ‘robotic resection', ‘RAMIE', ‘RATE'. Results: Hybrid and total minimally invasive operative techniques have proven beneficial, especially with regard to pulmonary complications, compared to open surgery. Oncologic outcomes appear equivalent between open and minimally invasive techniques. Currently, the position of RAMIE is being evaluated against other minimally invasive techniques. Conclusion: All minimally invasive techniques confer the expected reduction in perioperative morbidity compared to open surgery. However, MIS is still evolving with regard to specific technical challenges, especially anastomotic techniques.

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Robot-Assisted Minimally Invasive Ivor Lewis Esophagectomy With Real-Time Perfusion Assessment

Cited by 51 publications

References 27 publications

Clinical application of near-infrared thoracoscope with indocyanine green in video-assisted thoracoscopic bullectomy

Clinical application of near-infrared thoracoscope with indocyanine green in video-assisted thoracoscopic bullectomy

Robotic surgery for esophageal cancer: Merits and demerits

Upper Gastrointestinal Surgery: Robotic Surgery versus Laparoscopic Procedures for Esophageal Malignancy

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