Patient In Semiprone Position Research Articles

O100 WORLDWIDE TECHNIQUES AND OUTCOMES OF ROBOT-ASSISTED MINIMALLY INVASIVE ESOPHAGECTOMY (RAMIE): RESULTS FROM THE INTERNATIONAL UGIRA REGISTRY

Abstract Aim The aim of this study was to gain insight in the techniques and outcomes of RAMIE worldwide. Background & Methods Although robot-assisted minimally invasive esophagectomy (RAMIE) is increasingly adopted. The current literature on RAMIE mainly consists of single-center case series with considerable variation in reported techniques and outcomes. To gain an overview of the worldwide practice in RAMIE, an online registry was established by the Upper GI International Robotic Association (UGIRA). The collected data involve patient- and treatment characteristics, as well as postoperative outcomes that include complications as defined by the Esophageal Complications Consensus Group, length of stay, re-admissions (i.e. <30 days after discharge), mortality (i.e. in-hospital or <30 days after surgery), and pathological results. The outcomes were descriptively analyzed for this interim report. Results A total of 434 patients who underwent RAMIE for esophageal cancer between 2016-2019 were included in this interim analysis. The mean age was 63 years (SD ±9.7), the majority was male (n=359, 83%), and nearly all patients had an ASA score ≥2 (n=398, 92%). Adenocarcinoma (n=253, 58%) and squamous cell carcinoma (n=162, 37%) were most prevalent. The usual surgical approach was transthoracic (n=428, 99%) with the patient in semiprone position (n=393, 91%). Gastric conduit reconstruction was performed in all except one patient, who received a colonic interposition. The anastomosis was created by hand-sewing (n=207, 48%), circular stapling (n=142, 32%), or linear stapling (n=85, 20%). The median intraoperative blood loss was 120 milliliters (IQR 70-280) and the median operating time was 392 minutes (IQR 353-455). Postoperative complications occurred in 251 patients (59%) and mainly involved pulmonary complications (n=138, 32%), anastomotic leakage (n=80, 18%), and cardiac complications (n=55, 13%). Mortality occurred in 9 patients (2%) and re-admission because of complications was required in 57 patients (14%). A median of 28 lymph nodes (IQR 21-35) were removed and a radical resection was achieved in 400 patients (92%). Conclusion The presented results are the first to provide an overview of the techniques that are commonly used in RAMIE. By demonstrating results that are in line with recent benchmarking literature, this study demonstrates the safety and feasibility of RAMIE.

Technical aspects for laparoscopic liver resections of tumors in proximity to major vessels

Background: Bleeding during parenchymal division of the liver still remains a major complication of hepatectomy leading to 20% of perioperative deaths. The development of several transection devices, laparoscopic techniques for inflow and outflow control and the positive pressure of the CO2-pneumoperitoneum are the main reasons for less blood loss during laparoscopic resections(LLRs).However, tumors in proximity to major vasculature are often resected by open liver surgery. Methods: We describe several techniques which were helpful to prevent blood loss during LLRs with tumors in proximity to major vessels. Results: CVP drop was used to select patients for a laparoscopic approach when the tumor was located in segment 1 or in proximity to the hepatocaval confluence.The use of a laparoscopic Pringle manoeuver and a hanging manoeuver of the right hepatic vein to control the hepatocaval confluence are shown (figure).Advantages of placing the patient in semiprone position during LLRs in the posterosuperior segments are explained.In total 60 patients underwent a LLR for lesions in proximity of the major vessels. Median distance to major vessels was 10 mm (range 0–17). Operative time was 180.0min(IQR:140.0-210.0),median blood loss was 190.0 ml(IQR:100.0–325.0).Transfusion rate was 5.0%.Postoperative complication rate was 15.0%.There was no mortality. There was no significant correlation between the distance to major vasculature and blood loss (p = 0.80) or operative time (p=0.95). Correlation between CVP drop and blood loss was borderline significant (p=0.06) Conclusion: When using a range of techniques to prevent blood loss LLRs for lesions in proximity to major vessels are feasible and safe.