title: Robot-assisted thoracoscopic lymphadenectomy along the left recurrent laryngeal nerve for esophageal squamous cell carcinoma in the prone position: technical report and short-term outcomes.
abstract: BACKGROUND
  Meticulous mediastinal lymphadenectomy frequently induces recurrent laryngeal nerve palsy (RLNP). Surgical robots with impressive dexterity and precise dissection skills have been developed to help surgeons perform operations. The objective of this study was to determine the impact on short-term outcomes of robot-assisted thoracoscopic radical esophagectomy performed on patients in the prone position for the treatment of esophageal squamous cell carcinoma, including its impact on RLNP.
  
  
  METHODS
  A single-institution nonrandomized prospective study was performed. The patients (n = 36) with resectable esophageal squamous cell carcinoma were divided into two groups: patients who agreed to robot-assisted thoracoscopic esophagectomy with total mediastinal lymphadenectomy performed in the prone position (n = 16, robot-assisted group) without insurance reimbursement, and those who agreed to undergo the same operation without robot assistance but with health insurance coverage (n = 20, control group). These patients were observed for 30 days following surgery to assess short-term surgical outcomes, including the incidence of vocal cord palsy, hoarseness, and aspiration.
  
  
  RESULTS
  Robot assistance significantly reduced the incidence of vocal cord palsy (p = 0.018) and hoarseness (p = 0.015) and the time on the ventilator (p = 0.025). There was no in-hospital mortality in either group. There were no significant differences between the two groups with respect to patient background, except for the use of preoperative therapy (robot-assisted group <control, p = 0.003). There were no significant differences in estimated blood loss, operating time, number of dissected lymph nodes, completeness of resection, or the incidence of the other complications, except for anastomotic leakage (p = 0.038).
  
  
  CONCLUSIONS
  Robot-assisted thoracoscopic esophagectomy with total mediastinal lymphadenectomy is feasible and safe. This method shows promise in preventing RLNP.
authors.affiliation: Division of Upper GI, Department of Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake, Toyoake, 470-1192, Aichi, Japan. ko-suda@nifty.com
authors.forename: Koichi
authors.initials: K
authors.lastname: Suda
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Ishida
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Kawamura
authors.forename: Kazuki
authors.initials: K
authors.lastname: Inaba
authors.forename: Seiichiro
authors.initials: S
authors.lastname: Kanaya
authors.forename: Satoshi
authors.initials: S
authors.lastname: Teramukai
authors.forename: Seiji
authors.initials: S
authors.lastname: Satoh
authors.forename: Ichiro
authors.initials: I
authors.lastname: Uyama
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006685:Hoarseness / Q000517:prevention & control; D006801:Humans; D008197:Lymph Node Excision / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control*; D016684:Prone Position; D011446:Prospective Studies; D012009:Recurrent Laryngeal Nerve / Q000473:pathology; D012371:Robotics; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome; D014826:Vocal Cord Paralysis / Q000517:prevention & control