Technical aspects and early results of robotic esophagectomy with chest anastomosis.
OBJECTIVE
Minimally invasive esophagectomy with a chest anastomosis has advantages. We present technical lessons learned and early results.


METHODS
A retrospective review was conducted of minimally invasive laparoscopic and robotic Ivor Lewis esophagectomy.


RESULTS
Over 10 months, 22 patients (19 men) underwent laparoscopic gastric mobilization, with robotic esophagectomy. All had the thoracic portion completed robotically and 21 had the stomach mobilized laproscopically. All had esophageal cancer and 20 received neoadjuvant chemoradiotherapy. All had R0 resection with a median of 18 lymph nodes removed and a blood loss of 40 mL. The first 6 patients underwent a stapled posterior and hand-sewn anterior anastomosis; five of these patients experienced a major morbidity, including 1 anastomotic leak and 1 leak from the gastric staple line. The last 16 patients had a 2-layered completely hand-sewn anastomosis, and there were no anastomotic leaks or major morbidities. There were no 30- or 90-day mortalities. Technical improvements included placing a loop around the esophagus in the abdomen for third arm retraction, advancing the gastric conduit into the chest using nonrobotic instruments, using 10-cm nonabsorbable interrupted sutures for the outer layer, and a running 22-cm long absorbable suture for the inner layer.


CONCLUSIONS
Robotic thoracic esophagectomy using ports only is feasible, safe, and affords R0 resection with thorough thoracic lymph node dissection. It also allows the sewing of a 2-layered chest anastomosis with good early results.
Division of Thoracic Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Ala 35294, USA. rcerfolio@uab.edu
Robert James
RJ
Cerfolio
Ayesha S
AS
Bryant
Mary T
MT
Hawn
D000368:Aged; D000714:Anastomosis, Surgical; D059186:Chemoradiotherapy, Adjuvant; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D012189:Retrospective Studies; D012371:Robotics; D013270:Stomach / Q000601:surgery; D025321:Surgery, Computer-Assisted / Q000009:adverse effects; D017792:Surgical Stapling; D013536:Suture Techniques; D013906:Thoracoscopy / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome