Robotic Ivor Lewis Esophagectomy Research Articles

Robotic Ivor-Lewis esophagectomy in 15 steps.

Robotic Ivor-Lewis esophagectomy in 15 steps.

Fully Robotic Side-to-Side Linear-Stapled Anastomosis During Robotic Ivor Lewis Esophagectomy.

The adoption of robotic surgery for esophageal cancer has been expanding rapidly over the recent years. In the setting of two-field esophagectomy, different techniques exist for intrathoracic esophagogastric anastomosis, although the superiority of one over another has not been clearly demonstrated. Potential benefits in terms of anastomotic leakage and stenosis have been reported in association with a linear-stapled anastomosis as compared to the more widespread techniques of circular mechanical and hand-sewn reconstructions, however, there is still limited reported evidence on its application to robotic surgery. We here report our fully robotic technique of side-to-side, semi-mechanical anastomosis. All consecutive patients undergoing fully robotic esophagectomy featuring intrathoracic side-to-side stapled anastomosis by a single surgical team were included in this analysis. Operative technique is detailed, and perioperative data are assessed. A total of 49 patients were included. There were no intraoperative complications and no conversion occurred. The rate of overall postoperative morbidity was 25, 14% being the relative rate of major complications. With anastomotic-related morbidity in particular, one patient developed minor anastomotic leakage. Our experience demonstrates that a linear, side-to-side fully robotic stapled anastomosis can be created with a high technical success and minimal incidence of anastomosis-related morbidity.

Intrathoracic Robotic-Sewn Anastomosis During Ivor Lewis Esophagectomy for Cancer: Back to Basics?

BackgroundTo assess the feasibility, clinical utility, and safety of intrathoracic robotic-sewn esophageal anastomosis (IrEA) during Ivor Lewis esophagectomy for adenocarcinoma of the lower third of the esophagus, or cancer at the gastro-esophageal junction type I (Siewert classification). MethodsA protocol for completely robotic Ivor Lewis esophagectomy (CrIE) and intrathoracic robotic-sewn anastomosis (IrEA) was established at the authors’ institutions from January 2015 through December 2019. Overall surgery-related postoperative complications were analyzed. Overall survival and disease-free survival analysis were performed using standard methods. ResultsThe study population consisted of 40 patients. Median operative time was 320 min (sd 62, range 235–500 min), and conversion to open rate was 0%. Anastomotic leak rate was 10%. The mean number of examined lymph nodes (ELN) was 19 (IQR 11–29), and the mean number of positive lymph nodes (PLN) was 3 (IQR 0–5). Short- and long-term surgical and oncological outcomes were comparable at a medium follow-up of 37 months. The median overall survival was 48 months while the mean disease-free survival was 29 months. ConclusionThis pilot series, in which an intrathoracic robotic-sewn anastomosis (IrEA) was performed during CrIE, demonstrated the safety and feasibility of this approach. Compared to the current standard of care at a high-volume center, IrEA was associated with better postoperative surgical outcomes and similar oncological outcomes to those reported worldwide today. These results call for further validation in a prospective and controlled setting to be fully incorporated into clinical practice.

How to do robotic Ivor Lewis esophagectomy for lower third oesophageal cancer.

Transthoracic subtotal esophagectomy with two-field lymph node (mediastinal and abdominal) and monobloc posterior mediastinectomy is called Ivor Lewis esophagectomy. This intervention requires an abdominal and thoracic time that is carried out here entirely by robotic way. It is performed a reconstruction by gastroplasty with a manual esophago-gastric anastomosis also by robotic way.

Double purse-string suture technique for circular-stapled anastomosis during robotic Ivor Lewis esophagectomy.

BackgroundWith the advantage of the robotic suturing capacity, the purse-string suture is technically simple and convenient. This study aimed to present our technical aspects and initial results of robotic Ivor Lewis esophagectomy using two purse-string sutures for circular-stapled anastomosis.MethodsAfter stomach mobilization, gastric conduit formation, esophagus mobilization and two-field lymphadenectomy, the first robotic hand-sewn purse-string suture was applied to the esophageal muscular layer with an adequate margin above the tumor. A longitudinal incision in the anterior wall of the esophagus was made and the circular stapler anvil was inserted. The esophagus was transected by scissors 1 cm caudal to the first purse-string suture and the purse-string tied to secure the anvil. Then the second robotic hand-sewn purse-string suture was applied to the whole-layer of the proximal end of the esophagus and tied. Finally, the anvil was connected to the body of the stapler and fired.ResultsThe clinical data of ten patients who underwent robotic Ivor Lewis esophagectomy with an intrathoracic circular-stapled end-to-side anastomosis from February 2022 to April 2022 were collected. There were seven male and three female patients and had a mean age of 63.2 ± 7.6 years. Tissue donuts were complete in all cases and all operations were successfully performed without conversions. The mean overall operative time was 358.2 ± 40.3 min. The mean estimated blood loss was 83.2 ± 15.6 ml. The median length of hospital stay was 11.5 ± 4.1 days. All the patients had an uneventful postoperative period.ConclusionTwo purse-string sutures are necessary to obtain a tight seal of the esophageal tissue around the anvil to avoid potential anastomotic leak and are an essential process for the safety of circular-stapled anastomosis during robotic Ivor Lewis esophagectomy.

Robotic Ivor Lewis esophagectomy for gastroesophageal junction cancer (with video).

Robotic Ivor Lewis esophagectomy for gastroesophageal junction cancer (with video).

Double-Docking Technique, an Optimized Process for Intrathoracic Esophagogastrostomy in Robot-Assisted Ivor Lewis Esophagectomy.

BackgroundThough robotic Ivor Lewis esophagectomy has been increasingly applied, intrathoracic esophagogastrostomy is still a technical barrier. In this retrospective study, we introduced a double-docking technique for intrathoracic esophagogastrostomy to optimize surgical exposure and facilitate intrathoracic anastomosis. Moreover, we compared the clinical outcomes between the double-docking technique and anastomosis with a single-docking procedure in robotic Ivor Lewis esophagectomy.MethodsFrom March 2017 to September 2020, the clinical data of 68 patients who underwent robotic Ivor Lewis esophagectomy were reviewed, including 23 patients who underwent the double-docking technique (double-docking group) and 45 patients who underwent single-docking robotic esophagectomy (single-docking group). All patients were diagnosed with esophageal cancer or gastro-esophageal junction by biopsy before surgery. The technical details of the double-docking technique are described in this article.ResultsThere was no difference in the patient demographics data between the two groups. The median surgical time in the double-docking group was slightly shorter than in the classic group without statistical difference (380 vs. 395 min, p = 0.368). In the double-docking group, the median blood loss was 90 mL, the median number of lymph nodes harvested was 17, and the R0 resection rates were 100% (23/23). There were no differences in the surgical outcomes between the two groups.ConclusionsBased on our experience, the double-docking technique provides good surgical exposure when fashioning anastomosis, and such a technique does not increase the surgical time. Therefore, we believe that the double-docking technique is a safe and effective method for intrathoracic esophagogastrostomy while providing good exposure and ensuring the convenience and reliability of intrathoracic anastomosis.

How I do it: robotic-assisted Ivor Lewis esophagectomy.

Advances in minimally invasive techniques, including robotic surgical technology, have led to improved outcomes in esophagectomy. In this article, we detail our approach to the robotic Ivor Lewis esophagectomy.

Robotic Ivor-Lewis esophagectomy for distal esophageal and esophagogastric junction cancer: A prospective study

Robotic Ivor-Lewis esophagectomy for distal esophageal and esophagogastric junction cancer: A prospective study

Technique for Robotic Ivor Lewis Esophagectomy with 6-cm Linear Stapled Side-to-Side Anastomosis.

Technique for Robotic Ivor Lewis Esophagectomy with 6-cm Linear Stapled Side-to-Side Anastomosis.

Robotic Side‐to‐Side and End‐to‐Side Stapled Esophagogastric Anastomosis of Ivor Lewis Esophagectomy for Cancer

Both linear-stapled side-to-side esophagogastric anastomosis (LSEA) and circular-stapled end-to-side esophagogastric anastomosis (CEEA) are frequently used following esophagectomy. The aims of the present study were to review our experience of robotic intrathoracic alimentary tract reconstruction and to compare the short-term surgical outcomes of LSEA and CEEA in robotic Ivor Lewis esophagectomy. A prospectively collected dataset from 79 consecutive patients who underwent robot-assisted Ivor Lewis esophagectomy from February 2016 to December 2018 was retrospectively analyzed. Two groups (LSEA and CEEA) were classified according to the anastomotic mode. Demographic data, intraoperative characteristics and short-term surgical outcomes were compared between the two groups. Two patients were converted to laparotomy. The remaining 77 patients (68 males and 9 females, mean age of 61.7years) were successfully treated with completely robotic Ivor Lewis esophagectomy. According to the anastomotic procedure performed, 35 patients were categorized into the LSEA group and 42 patients were categorized into the CEEA group. The mean anastomotic time in the LSEA group was longer than that in the CEEA group (63.0 ± 9.0 vs. 44.2 ± 8.5min, p < 0.001). No significant difference was detected in anastomotic complications, including leakage (8.6% with LSEA and 4.8% with CEEA, p = 0.83) and postoperative dysphagia (5.7% with LSEA and 16.7% with CEEA, p = 0.26). No statistical difference was observed for the other surgical outcomes. There was no incidence of in-hospital mortality and 30-day mortality in both groups. In robotic Ivor Lewis esophagectomy, both LSEA and CEEA were feasible and safe to be performed and surgeons can select either LSEA or CEEA based on their own technical expertise.

196 – Totally Robotic Ivor-Lewis Esophagectomy with Intrathoracic Robot-Sewn Anastomosis for Cardioesophageal Cancer with the Da Vinci Xi

196 – Totally Robotic Ivor-Lewis Esophagectomy with Intrathoracic Robot-Sewn Anastomosis for Cardioesophageal Cancer with the Da Vinci Xi

Robotic Ivor Lewis esophagectomy: evolving technique to optimize outcomes

We describe our current, evolving technique to completely portal robotic Ivor Lewis esophagectomy including; port placement, conduct of surgery, and pearls for the optimal anastomosis garnered by our experience of 163 patients (158 Ivor Lewis, 5 McKeown). We outline the thoracic and abdominal phases of the operation and demonstrate that this procedure is safe, feasible, and oncologically-sound.

Readmission after robotic Ivor Lewis esophagectomy: Earlier discharge, increased readmissions?

149 Background: Readmissions after esophagectomy are costly and incidence can be as high as 25%. The robotic assisted approach has potential benefits of earlier discharge compared to conventional techniques, however it is unclear what impact an earlier discharge will have on readmission rates. We sought to examine the impact of early discharge on readmission rates with robotic approaches. Methods: A retrospective review of all patients undergoing robotic assisted Ivor Lewis esophagectomy (RAIL) from 2009-2015 was conducted. Clinicopathologic factors and surgical outcomes were recorded and compared. We then compared outcomes to a historical cohort from the Surveillance, Epidemiology, and End Results-Medicare data (2002 to 2009). Length of stay, 30-day and 90-day readmissions, and mortality were determined. All statistical tests were two-sided and a p-value &lt; 0.05 was considered statistically significant. Results: We identified 147 patients who underwent RAIL. There were 78.9% (116) male with an average age 66 ±10 years. Adenocarcinoma was the predominant histology in 86% (126) patients, 9.52% (14) patients had squamous cell histology, and 4.76% (7) patients had other histology. Neoadjuvant therapy was administered to 77.6% (114) patients. In the SEER database 1,744 patients with esophageal cancer underwent esophagectomy: 80% of patients (1,390) were male, with a mean age of 73 years; 71.8% of tumors (1,251) were adenocarcinomas, and 38% of patients (667) received neoadjuvant therapy. Median length of stay was 13 days, 30-day mortality was 8.8% (158 patients), and 90 day mortality was 17.9% (302) compared to median LOH of 9 days, 30-day mortality of 0.6% (1) and 90-day mortality of 1.4% (2)% in the robotic cohort, p &lt; 0.0001, p = 0.007, and p &lt; 0.0001. Readmission rates at 30 and 90 days were 18.6% (212) and 31.3% (356) in the SEER patients, and 3.4% (5) and 5.4% (8) in the robotic cohort p = 0.001 and p &lt; 0.001. Conclusions: RAIL is a safe surgical technique that provides an alternative to conventional approaches to esophageal resection. Patients undergoing RAIL had lower mortality rates and LOH. Despite the lower LOH, RAIL was associated with lower 30 and 90-day readmissions.

Robotic Esophagectomy for Cancer: Early Results and Lessons Learned

Minimally invasive esophagectomy with intrathoracic dissection and anastomosis is increasingly performed. Our objectives are to report our operative technique, early results and lessons learned. This is a retrospective review of 85 consecutive patients who were scheduled for minimally invasive Ivor Lewis esophagectomy (laparoscopic or robotic abdominal and robotic chest) for esophageal cancer. Between 4/2011 and 3/2015, 85 (74 men, median age: 63) patients underwent robotic Ivor Lewis esophageal resection. In all, 64 patients (75%) had preoperative chemoradiotherapy, 99% had esophageal cancer, and 99% had an R0 resection. There were no abdominal or thoracic conversions for bleeding. There was 1 abdominal conversion for the inability to completely staple the gastric conduit. The mean operative time was 6 hours, median blood loss was 35ml (no intraoperative transfusions), median number of resected lymph nodes was 22, and median length of stay was 8 days. Conduit complications (anastomotic leak or conduit ischemia) occurred in 6 patients. The 30 and 90-day mortality were 3/85 (3.5%) and 9/85 (10.6%), respectively. Initial poor results led to protocol changes via root cause analysis: longer rehabilitation before surgery, liver biopsy in patients with history of suspected cirrhosis, and refinements to conduit preparation and anastomotic technique. Robotic Ivor Lewis esophagectomy for cancer provides an R0 resection with excellent lymph node resection. Our preferred port placement and operative techniques are described. Disappointingly high thoracic conduit problems and 30 and 90-day mortality led to lessons learned and implementation of change which are shared.

Perioperative outcomes associated with robotic Ivor Lewis esophagectomy in patient's undergoing neoadjuvant chemoradiotherapy.

Neoadjuvant chemoradiotherapy (NCR) for the treatment of esophageal cancer has been associated with increased perioperative morbidity and mortality. Minimally invasive procedures utilizing robotic techniques have been shown to reduce perioperative complications and length of hospitalization (LOH). The purpose of this study is to compare perioperative outcomes between patients undergoing NCR and robotic-assisted Ivor Lewis esophagectomy (RAIL) versus upfront RAIL. A database of esophagectomy patients was queried to identify RAIL patients. Differences in perioperative outcomes were analyzed between NCR and non NCR patients. Eighty-nine patients were identified who underwent RAIL Seventy-seven patients (87%) had NCR and 22 patients did not (13%). The median age was 66 (range, 44-83). The median age of the patients treated with NCR was younger {69 [44-83] vs. 64 [46-81] years respectively, P=0.05}. The patients who underwent NCR had a higher BMI then those who went straight to esophagectomy (31 vs. 27; P=0.001). There were no conversions to open laparotomy or thoracotomy in either group. There were no statistically significant differences in the mean operative times and estimated blood loss (EBL) between both groups. Complications occurred in 17 (19.1%) patients. There were no statistically significant differences in the rates of any complications between patients receiving NCR and those that did not receive NCR (P=0.11). There were no deaths in either group. The total number of days in hospital and total number of intensive care unit (ICU) days were also similar in both groups (P=0.25). There was no statistically significant difference in the mean number of lymph nodes harvested in the patients treated with NCR compared with those treated without NCR. We have demonstrated that RAIL is a safe and feasible option for patients with esophageal cancer. The administration of NCR to RAIL did not result in an increase in perioperative morbidity and mortality. The number of lymph nodes harvested and the completeness of resection was also similar between patients who received NCR and those who did not. Longer follow-up is required in order to determine long term oncologic outcome.

Minimally invasive and robotic Ivor Lewis esophagectomy.

Esophageal cancer is the eighth most common malignancy and the sixth most common cause of cancer-related death worldwide. Esophagectomy provides a curative treatment but carries significant morbidity and mortality. Ivor Lewis esophagectomy (ILE) is one of the most commonly employed open techniques of esophagectomy. Minimally invasive approaches have been explored in ILE in an effort to reduce operative morbidity. This article reviews recent literature of minimally invasive Ivor Lewis esophagectomy (MI-ILE), discusses its clinical outcomes, and introduces the robotic approach in MI-ILE. MI-ILE has demonstrated comparable postoperative outcomes to open ILE, and it has shown potential to reduce blood loss and length of hospitalization. Due to limited studies, no significant improvement of long-term survival has been reported in MI-ILE. Robotic ILE is safe and feasible, but more studies are needed to prove identifiable benefits. Randomized controlled trials comparing MI-ILE or robotic ILE with conventional open ILE are warranted to determine the optimal surgical procedure for the treatment of esophageal cancer.