Combined thoracoscopic and laparoscopic robotic-assisted minimally invasive esophagectomy using a four-arm platform: Experience, technique and cautions during early procedure development Journal Article
| Authors: | Sarkaria, I. S.; Rizk, N. P.; Finley, D. J.; Bains, M. S.; Adusumilli, P. S.; Huang, J.; Rusch, V. W. |
| Article Title: | Combined thoracoscopic and laparoscopic robotic-assisted minimally invasive esophagectomy using a four-arm platform: Experience, technique and cautions during early procedure development |
| Abstract: | OBJECTIVES: This study reports an early, single-institution experience of combined thoracoscopic and laparoscopic robotic-assisted minimally invasive esophagectomy (RAMIE) using a four-arm robotic platform, with special attention given to the pitfalls and complications during procedure development. METHODS: We conducted a prospective, single-cohort, observational study of patients undergoing RAMIE at a single institution. RESULTS: A total of 21 patients (median age, 62 years [range, 37-83 years]) underwent RAMIE with a four-arm robotic platform (17 by Ivor Lewis and 4 by McKeown). Of the patients, 17 (81%) had a complete (R0) resection, and 16 (76%) received induction treatment, the majority (14/21 [67%]) with combined chemoradiation. The median operative time was 556 min (range, 395-807 min), which decreased to 414 min (range, 405-543 min) for the last 5 cases in the series. The median estimated blood loss was 307 cm3 (range, 200-500 cm3), and the median length of hospital stay was 10 days (range, 7-70 days). The median number of lymph nodes resected was 20 (range, 10-49). Five (24%) patients were converted to open procedures. Five patients (24%) had major complications. One (5%) died of complications on postoperative Day 70, and 3 (14%) had clinically significant anastomotic leaks (Grade II or greater, by Common Terminology Criteria for Adverse Events version 3.0). Three patients (14%) in this early experience developed airway fistulas. CONCLUSIONS: While four-arm RAMIE may offer advantages over standard minimally invasive esophagectomy approaches, its adoption in a structured program, with critical evaluation of adverse events and subsequent adjustment of technique, is paramount to maximize patient safety, minimize complications and improve the conduct of operation early in the learning curve. Particular technical consideration should be given to prevention of airway complications. © The Author 2013. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved. |
| Keywords: | adult; clinical article; aged; aged, 80 and over; middle aged; postoperative period; note; lymph node dissection; laparoscopy; laparoscopic surgery; prospective study; prospective studies; cohort studies; bleeding; pneumonia; lung embolism; postoperative complication; hospitalization; operation duration; esophagus resection; minimally invasive surgery; perioperative period; robotics; observational study; wound infection; thorax surgery; empyema; heart atrium fibrillation; thoracoscopy; esophageal neoplasms; esophagectomy; chemoradiotherapy; anastomosis, surgical; respiratory failure; anastomosis leakage; recurrent laryngeal nerve palsy; oesophageal cancer; operations; respiratory tract fistula; oesophageal surgery; surgery/incisions/exposures/techniques; robotic assisted minimally invasive esophagectomy; tracheobronchial fistula |
| Journal Title: | European Journal of Cardio-Thoracic Surgery |
| Volume: | 43 |
| Issue: | 5 |
| ISSN: | 1010-7940 |
| Publisher: | Oxford University Press |
| Date Published: | 2013-05-01 |
| Start Page: | e107 |
| End Page: | e115 |
| Language: | English |
| DOI: | 10.1093/ejcts/ezt013 |
| PROVIDER: | scopus |
| PUBMED: | 23371971 |
| DOI/URL: | |
| Notes: | --- - "Export Date: 3 June 2013" - "Art. No.: ezt013" - "CODEN: EJCSE" - "Source: Scopus" |
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