title: Robotically assisted esophago-esophagostomy in newborn pigs.
abstract: OBJECTIVE
  Repair of esophageal atresia and tracheoesophageal fistula (TEF) in the newborn is challenging when done as an open procedure but only a few surgeons have attempted this with minimally invasive surgery (MIS). Surgical robots that hold MIS instruments have wrists and provide tremor filtration and motion scaling, which might be expected to facilitate complex procedures in small spaces such as an esophageal anastomosis in a newborn.
  
  
  METHODS
  Seven newborn pigs weighing 2 to 3 kg were used as a model. The authors performed an esophageal resection and end-to-end anastomosis using the Zeus Microwrist Robotic Surgical System. The authors monitored the following data-Zeus robotic set-up time, operating time, esophageal dissection time, and anastomosis time. After 1 month, the animals were anesthetized to perform esophagram and than were killed.
  
  
  RESULTS
  In these very small animals the space available for performing an anastomosis is very limited, approximately 2 cm3. Two pigs each died 18 days postoperatively. One animal could not eat and died during esophageal dilation. The second pig died of unrelated enteritis. Neither had evidence of anastomotic leak at autopsy. The esophagram of the 5 pigs that survived for 30 days showed no narrowing or proximal dilation in 2. In 3 there was some stenosis requiring dilation. Histopathology was done on each operated animal. Two of the anastomoses were well healed, and 5 showed only focal small ulceration.
  
  
  CONCLUSIONS
  Robotic assistance facilitates an MIS approach to the upper esophagus even in the limited space of the infant chest.
authors.affiliation: Department of Surgery, Wayne State University School of Medicine and Children's Hospital of Michigan, Maxine and Stuart Frankel Foundation Computer-Assisted Robot-Enhanced Surgery Program, Children's Research Center of Michigan, Detroit, MI, USA.
authors.forename: Attila
authors.initials: A
authors.lastname: Lorincz
authors.forename: Scott E
authors.initials: SE
authors.lastname: Langenburg
authors.forename: Colin G
authors.initials: CG
authors.lastname: Knight
authors.forename: Kelly
authors.initials: K
authors.lastname: Gidell
authors.forename: Raja
authors.initials: R
authors.lastname: Rabah
authors.forename: Michael D
authors.initials: MD
authors.lastname: Klein
mesh_terms: D000714:Anastomosis, Surgical / Q000295:instrumentation / Q000379:methods; D000818:Animals; D000831:Animals, Newborn; D004106:Dilatation; D004867:Equipment Design; D004946:Esophagostomy / Q000295:instrumentation* / Q000379:methods; D004947:Esophagus / Q000473:pathology / Q000601:surgery; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation; D023421:Models, Animal; D012371:Robotics / Q000295:instrumentation; D034421:Sus scrofa; D013536:Suture Techniques; D013906:Thoracoscopy / Q000379:methods*; D014138:Tracheoesophageal Fistula / Q000601:surgery