Robotic Transhiatal Esophagectomy in a Community Hospital: Evolution of Technique

Abstract

Esophageal cancer is an uncommon but highly lethal disease. Surgical resection is the gold standard of treatment for early-stage disease. Traditional surgical approach entailed significant convalescence, hospital stay, and morbidity and mortality. Transhiatal esophagectomy (THE) involves blind dissection of the esophagus with minimal mediastinal lymphadenectomy. Integration of robotic surgery is an alternate platform for minimally invasive approach while maintaining safety and following oncologic principles. We review our technique for minimally invasive THE using robotic technology, demonstrating the safety and efficacy of robotic technology surgery. We present a retrospective review of a single surgeon's data of patients treated with robotic-assisted THE, with a chart review to evaluate pathology, adequacy of surgical resection, nodal harvest, and perioperative course. Robotic THE (rTHE) shows promise as a valid option for esophageal resection, including premalignant and advanced stages of cancer. Adequate transhiatal mediastinal nodal resection can be performed with the robot.

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

“…Interestingly, the authors reported using biologic mesh to reinforce the hiatus to address the issue of postoperative diaphragmatic hernias, a step rarely performed today [27,41] . Others have also reported similar outcomes [84][85][86][87] . More recently, Wecowski et al [88] prospectively reported their experience in incorporating a robotic platform for transhiatal esophagectomy.…”

THE Big Deal: An Institution's Experience with Robotic Transhiatal Esophagectomy

“…Similar issues with pulmonary complications after esophagectomy are found within both the transhiatal literature and transthoracic literature. 8,10,[13][14][15] Nearly one patient in 10 had an SSI, all of which were quite trivial and involved the incisions for the robotic trocars; some appeared after discharge and all resolved with antibiotics. This rate of SSIs seems high for our practice.…”