P103 A HAND-SEWN INTRATHORACIC ANASTOMOSIS IN ROBOT-ASSISTED MINIMALLY INVASIVE ESOPHAGECTOMY (RAMIE): A DETAILED DESCRIPTION OF TECHNIQUE AND OUTCOMES

Abstract

Abstract Aim The aim of this study was to describe a technique that was developed and refined to construct a hand-sewn intrathoracic anastomosis during robot-assisted minimally invasive esophagectomy (RAMIE). Background & Methods Whilst some case series have reported promising results of a hand-sewn intrathoracic anastomosis during RAMIE, the exact techniques were often not described in detail. Therefore, the current single-center retrospective study was designed to provide a detailed and reproducible technical description of a hand-sewn, intrathoracic anastomosis that was developed and refined for patients who underwent RAMIE in a high volume center for esophageal cancer surgery (2016-2018). Video recordings were reviewed to evaluate technical details regarding the anastomosis, including number of sutures and distances between the anastomosis and the longitudinal staple line or gastric conduit tip. Technical details and distances were extracted and measured by using video analysis software. Moving average analyses were performed to evaluate whether the anastomotic leakage rate changed over the consecutive cases. Results A total of 68 patients were included in the study. For creation of the anastomosis, the gastric conduit was opened on a median distance of 19 millimeters (range 0-66) from the gastric conduit tip. After initially performing end-to-end anastomoses, a switch was made to an end-to-side anastomosis for the majority of 55 patients (81%). A median total of 27 sews (range 20-38) were required to close the anastomosis. In the last 22 patients of the cohort (32%), 4 tension release stitches were placed after circular suturing of the anastomosis. A re-inforcing omental wrap was positioned around the anastomosis in 64 patients (94%). The moving average curve for anastomotic leakage started at a rate of 40% (cases 1-10) and ended at 10% (cases 59-68). Conclusion This is the first study to report technical features and outcomes of a hand-sewn intrathoracic anastomosis during RAMIE in detail. Although an acceptable anastomotic leakage rate was observed in the final inclusion phase, a hand-sewn intrathoracic anastomosis during RAMIE may carry a substantial learning curve.