Short-term outcomes of robot-assisted minimally invasive esophagectomy for esophageal cancer: a propensity score matched analysis

He, Haiqi; Wu, Qifei; Wang, Zhe; Zhang, Yong; Chen, Nanzheng; Fu, Junke; Zhang, Guangjian

doi:10.1186/s13019-018-0727-4

Cited by 53 publications

(73 citation statements)

References 30 publications

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“…Although it has been reported that robot assisted recurrent laryngeal nerve chain lymph nodes lymphadenectomy is not safe [10], and has no advantage over open surgery in tumor prognosis [11], Chen j et al [12], Deng et al [13] and Li Xu el al. [14] ound that RAMIE has a de nite advantage in lymphadenectomy without increasing the risk of major postoperative complications.…”

Section: Discussionmentioning

confidence: 99%

Robot-assisted esophageal surgery using the da Vinci® Xi system for Benign and malignant diseases of esophagus：Preliminary experience of robot assisted modified Sweet operation

Sun

Wang

et al. 2020

Preprint

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Background Since our hospital installed the DaVinci ® Xi system, we have performed 60 thoracic surgeries in four months. As 25 of these 60 patients contain various types of esophageal benign and malignant diseases, we have no time to summarize our work after understanding and learning the experience of previous experts, so as to share our preliminary experience in using DaVinci ® Xi system in esophageal surgery. Because robot surgery system is the most effective for small and hard to reach areas, we have made many attempts in benign esophageal diseases. Compared with DaVinci ® Si, DaVinci ® Xi has many new functions, so we explore new surgical methods for some special esophageal cancer cases, such as the robot assisted modified Sweet operation.Methods Using DaVinci® Xi system(Intuitive Surgical, China), we performed robotic assisted thoracoscopic surgery (RATS) on 15 patients with esophageal cancer and 10 patients with various types of esophageal benign diseases. Among all esophageal cancer patients, 6 patients with lower esophageal cancer underwent resection of left thoracic esophageal cancer and lymphadenectomy, then diaphragm was cut, stomach was separated from abdominal cavity and lymphadenectomy was performed. Finally, 5 cases were anastomosed with stomach and esophagus under the aortic arch, and 1 case was anastomosed with stomach and esophagus in the neck combined with mediastinoscopic neck lymphadenectomy. McKeown was performed in 3 of the other 9 cases. Six patients underwent the Ivor Lewis operation, one of them was converted to the left thoracogastrostomy because of the extensive adhesion of the right thoracic cavity. Other benign diseases included esophageal leiomyomectomy in 3 cases, esophageal diverticulum in 1 case, hiatal hernia in 4 cases, esophageal cyst in 1 case, achalasia in 1 case. Results All the procedures were successfully completed by robot except one patient with extensive adhesion of right thoracic cavity and only abdominal operation. The median operation time of esophageal cancer patients was 286（240-348 minutes,There were no complications during operation. One patient had a neck anastomotic leakage and the wound healed after local washing for 3 weeks. Because of the short time of observation, there is no death of malignant tumor and no serious complication of benign disease. Conclusions Through the experience of such a small series of robotic assisted thoracoscopic surgery for various esophageal diseases, we support the impression that: 1. The esophagus is an ideal organ for robotic surgery, which is a good indication for malignant tumor surgery; 2. Under the vision of the robot, each layer of esophageal mucosa can be seen clearly, which is very conducive to the resection of small leiomyoma or cyst In addition, 3. Flexible arms can be used for various anastomosis or suture operations. 4. Through the left thorax and diaphragm incision can be used as a "robot" Sweet operation for the right patient, with mediastinoscopy to clean up the upper mediastinal lymph nodes can achieve better results.

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Section: Discussionmentioning

confidence: 99%

Robot-assisted esophageal surgery using the da Vinci® Xi system for Benign and malignant diseases of esophagus：Preliminary experience of robot assisted modified Sweet operation

Sun

Wang

et al. 2020

Preprint

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“…There was no significant difference between the two groups with respect to the mean number of dissected lymph nodes (20 and 19, respectively; P = 0.420), duration of postoperative hospital stay (13.8 and 12.7 days, respectively; P = 0.548), overall rate of complications (37.0% and 33.3%, respectively; P = 0.776), rate of RLN injury (14.8% and 11.1%, respectively; P = 1.000), and rate of pneumonia (18.5% and 7.4%, respectively; P = 0.224). The authors concluded that the short‐term outcomes of RAMIE and VAMIE are comparable, and that RAMIS is safe and feasible . van der Sluis et al reported the short‐term and long‐term outcomes in 108 cases of RAMIE.…”

Section: Robotic Surgerymentioning

confidence: 99%

“…Mortality rate was 5% (one patient) as a result of a tracheoesophageal fistula . Propensity score matching analysis of RAMIE versus conventional video‐assisted minimally invasive esophagectomy (VAMIE) was reported in 2018 . Matching based on propensity scores produced 27 patients in each group.…”

Section: Robotic Surgerymentioning

confidence: 99%

Current status of minimally invasive esophagectomy for esophageal cancer: Is it truly less invasive?

Oshikiri

Takiguchi

Miura

et al. 2018

Annals of Gastroent Surgery

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Esophagectomy with extended lymphadenectomy remains the mainstay of treatment for localized esophageal cancer. However, it is one of the most invasive procedures with high morbidity. To reduce invasiveness, minimally invasive esophagectomy (MIE), which includes thoracoscopic, laparoscopic, mediastinoscopic, and robotic surgery, is becoming popular worldwide. Thoracoscopic esophagectomy in the prone position is ergonomic for the surgeon and has better perioperative arterial oxygen pressure/fraction of inspired oxygen (P/F) ratio. Thoracoscopic esophagectomy in the left decubitus position is easy to introduce because it is similar to standard right posterolateral open esophagectomy (OE) in position. It has a relatively short operative time. Laparoscopic approach could potentially have a substantial effect on pneumonia prevention under the condition of thoracotomy. Mediastinoscopic surgery has the potential to reduce pulmonary complications because it can avoid a transthoracic procedure. In robotic surgery, in the future, less recurrent laryngeal nerve palsy will be expected as a result of polyarticular fine maneuvering without human tremors. In studies comparing MIE with OE, mediastinoscopic surgery and robotic surgery are usually not included; these studies show that MIE has a longer operative time and less blood loss than OE. MIE is particularly beneficial in reducing postoperative respiratory complications such as atelectasis, despite no dramatic decrease in pneumonia. Reoperation might occur more frequently with MIE. There is no significant difference in mortality rate between MIE and OE. It is important to recognize that the advantages of MIE, particularly “less invasiveness”, can be of benefit at facilities with experienced medical personnel.

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“…A previous retrospective study from the same group showed that RAMIE can be performed with a high percentage of R0 radical resections, an adequate lymphadenectomy, an acceptable morbidity rate, and a low percentage (6%) of local recurrence after 5 years . On the contrary, the robot might also have some disadvantages, such as higher costs, more time‐consuming procedures, and the lack of tactile feedback . The proficiency gain curve might be even longer than for MIE although no large studies have been completed to support this assumption .…”

Section: Robotic Esophagectomymentioning

confidence: 99%

“…40 On the contrary, the robot might also have some disadvantages, such as higher costs, more time-consuming procedures, and the lack of tactile feedback. 44 The proficiency gain curve might be even longer than for MIE although no large studies have been completed to support this assumption. 45 In addition, these systems are unavailable for surgeons in all countries.…”

Section: Robotic Esophagectomymentioning

confidence: 99%

The evolution of surgical approach for esophageal cancer

Gisbertz

Hagens

Ruurda

et al. 2018

Annals of the New York Academy of Sciences

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Esophageal surgery for esophageal cancer has been performed for over a century now. Minimally invasive esophagectomy (MIE) was first described in 1992, and it is now a standard approach in many countries. However, MIE is technically difficult and requires a long learning curve. It takes >100 cases to train for MIE with gastric tube reconstruction with an intrathoracic anastomosis. A possible option to overcome several challenges of MIE might be the use of a robotic system. A robot-assisted MIE was first described in 2005, and long-term results have shown its feasibility and safety. Over the years, different approaches for esophagectomy have been established. Our review discusses these developments and recent literature on open, minimally invasive and robotic esophageal surgery.

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Short-term outcomes of robot-assisted minimally invasive esophagectomy for esophageal cancer: a propensity score matched analysis

Cited by 53 publications

References 30 publications

Robot-assisted esophageal surgery using the da Vinci® Xi system for Benign and malignant diseases of esophagus：Preliminary experience of robot assisted modified Sweet operation

Robot-assisted esophageal surgery using the da Vinci® Xi system for Benign and malignant diseases of esophagus：Preliminary experience of robot assisted modified Sweet operation

Current status of minimally invasive esophagectomy for esophageal cancer: Is it truly less invasive?

The evolution of surgical approach for esophageal cancer

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