OGC V05 Robotic intrathoraxic linear stapled anastomosis following Ivor Lewis oesophagectomy

Abstract

Abstract Background Ivor lewis oesophagectomy (ILO) for oesophageal cancer (OC) is associated with high morbidity with an anastomotic leak (AL) rate of upto 30% been quoted in literature. This can lead to return to intensive care, delayed recovery and mortality. Several techniques have been developed in an attempt to reduce this risk such as, hand sewn technique, circular anastomosis and side to side linear stapled anastomosis (LSA). Recent meta-analysis suggested reduced AL with LSA. We demonstrate our technique for a totally robotic side to side LSA performed for distal OC. Methods We detail the steps involved in the procedure, including trocar placement, necessary robotic instruments, and surgical description. 74 year old male patient with a BMI of 30 and performance status of 1, underwent robotic ILO for a Siewert type 1 T2N1 distal oesophageal adenocarcinoma after neo-adjuvant chemotherapy. Preoperatively staging investigations included endoscopy, endoscopic ultrasound, computerised tomography (CT) and positron emission tomography (PET). Fitness was assessed using cardio-pulmonary exercise testing (CPET). Results Patient was on the high dependency unit as per our routine practice for less than 24 hours and was transferred to our monitored ward bed. Enhanced recovery after surgery (ERAS) protocol was followed. There were no complications and patient was discharged in 8 days following ILO. Conclusions We demonstrate our technique using side to side LSA for robotic ILO.