181. SAFETY AND TIME USAGE OF CIRCULAR STAPLED ANASTOMOSIS IN THE SHIFT FROM MIE TO RAMIE

Abstract

Abstract Background Introducing new surgical techniques may increase the potential for adverse events. There is no consensus or evidence on the optimal anastomotic technique in esophageal resection. We used the circular stapled anastomosis (CSA) technique as standard in MIE, and continued this practice during the introduction of RAMIE. Here, we evaluate the early results of reconstruction during Iwor-Lewis esophagectomy using CSA after converting from MIE to RAMIE, with redspect to safety and time usage. Methods The first 27 RAMIEs were included, as well as an equal number of video recorded MIEs immediately preceeding the shift to RAMIE. Patient background and short-term outcomes were recorded prospectively. The duration of the reconstruction, i.e. the time from esophageal transection to transection of the blind limb of the gastric conduit was recorded from operative videos. Both MIE and RAMIE were performed in the prone position using single lumen tube intubation. The robot was not undocked during the reconstruction. Data was registered in a patient registry approved by the Institutional Data Protection Officer with written consent by all patients. Results 27 RAMIEs and 29 MIEs were included. Patient demographics, comorbidity and tumor disease stages were similar between the two groups. There were video recordings of 26 cases in each group. There were no conversions to thoracotomy in either group. All reconstructions were completed using CSA. The median duration of the reconstruction was 40 (range: 26–85) minutes in the MIE group and 46 (35–76) minutes in the RAMIE group (p = 0.02). There were three anastomotic leaks in each group (RAMIE 11% and MIE 10%). One patient died within 90 days of surgery in the MIE group. Conclusion In this study, the use of CSA during RAMIE for the reconstruction in Iwor-Lewis esophagectomy was feasible with comparable anastomotic leak rate as after MIE. The average duration of reconstruction was 6 minutes longer in the RAMIE group.