Robotic-assisted Ivor Lewis esophagectomy: technique and early outcomes

Abstract

Esophagectomy is pivotal for the long-term survival in patients with early stage and advanced esophageal cancer, and improved perioperative care and advanced surgical techniques have contributed to reduced postoperative morbidity. However, despite these advances, esophagectomy continues to be associated with significant morbidity and mortality. Minimally invasive esophageal surgery (MIE) has been increasingly used in patients undergoing surgery for esophageal cancer. Potential advantages of MIE include the decreased postoperative pain; lower postoperative wound infection, decreased pulmonary complications, and decreased length of hospitalization. Robotic esophageal surgery has the ability to overcome some of the limitations of laparoscopic and thoracoscopic approaches to esophagectomy while maintaining the benefits of the minimally invasive approach. In this article, we will review the clinical efficacy and outcomes associated with robotic-assisted Ivor Lewis esophagectomy (RAIL).

Robotic esophagectomy: the evolution of open esophagectomy to current techniques and a review of the literature

“…RAILE demonstrated fewer complications (wound, pulmonary, cardiovascular, and overall) compared with open IL esophagectomies and duration of hospital stay was significantly lower in the RAILE versus open cohort. However, as expected, RAILE resulted in increased pulmonary complications compared to RATE [82] . Conversely, RATE demonstrated increased rates of major complications compared to RAILE including an increased risk of anastomotic leak, higher incidence of recurrent laryngeal nerve injuries, wound complications, and aspiration [82] .…”

“…However, as expected, RAILE resulted in increased pulmonary complications compared to RATE [82] . Conversely, RATE demonstrated increased rates of major complications compared to RAILE including an increased risk of anastomotic leak, higher incidence of recurrent laryngeal nerve injuries, wound complications, and aspiration [82] .…”

“…Morbidity was minimal, 30-day mortality was 0%, and they ultimately concluded that RAILE was a safe and oncologically sound procedure [62] . Since that time, many more have reported on their experience performing robotic IL esophagectomy [74][75][76][77][78][79][80][81] and more recently, Nora et al [82] reviewed outcomes of RAILE. When completed by an experienced surgeon, RAILE has comparable times to esophagectomies performed via minimally invasive approaches [28,83] .…”

Robotic-assisted Ivor Lewis esophagectomy—end-to-end anastomosis (EEA)

“…Robotic-assisted Ivor Lewis esophagectomy-end-to-end anastomosis (EEA) has been previously described. Retrospective reviews of robotic esophagectomies, utilizing the EEA stapler for an intrathoracic anastomosis, demonstrated a 0-15% leak rate (10)(11)(12)(13)(14)(15). One randomized controlled trial of sixty-one cases compared robotic-assisted esophagectomies and the utilization of stapled EEA or double-layered robotically sewn anastomoses in 2018.…”

Robot-assisted Ivor Lewis Esophagectomy (RAILE): A review of surgical techniques and clinical outcomes

“…The introduction of the da Vinci robotic system to esophagectomy, as a promising minimally invasive technique, aimed at reducing morbidity and mortality, improving long-term survival, and raising patients' quality of life. It has been nearly 20 years since the first reported case of robot-assisted minimally invasive esophagectomy (RAMIE) case, and RAMIE is now frequently applied in high-volume esophageal surgery centers around the world (4)(5)(6). The robotic platform's ergonomic design, tremor filtration, flexible articulation and three-dimensional vision, make it particularly suitable for a demanding esophagectomy which combines dissection and reconstruction in a deep dark cavity with important anatomical structures.…”