title: Contribution of robotics to minimally invasive esophagectomy.
abstract: Robot-assisted surgery has the advantages of a three-dimensional view, versatility of instruments and better ergonomics. It allows fine dissection and difficult anastomoses in deep fields. Based on our experience, we try to define what are the main contributions of robotics to minimally invasive esophagectomy. From December 2009 to July 2012, we performed 24 minimally invasive esophagectomies (9 transhiatal, 5 Ivor-Lewis and 10 three-field), 16 of them robotically (8, 5 and 3, respectively). Eighteen patients (18/24 = 75 %) received neoadjuvant therapy. Nine patients (9/24 = 37.5 %) had symptomatic complications: 4 anastomotic leaks treated conservatively, one staple failure of the gastric plasty needing reoperation, one biliary peritonitis secondary to a gangrenous cholecystitis, one intrathoracic gastric migration after the only nonresectable case, one chylothorax and one patient with major cardiopulmonary complications. The median number of lymph nodes harvested was 12 ± 7. Median length of stay was 14 ± 13.5 days. Thirty-day mortality was nil. Complications were not related to the robot itself but to the complexity of both the technique and the patient. Although we found no advantages for the use of robotics during threefield minimally invasive esophagectomy, robotic mediastinal dissection during transhiatal esophagectomy can be performed safely under direct vision. Moreover, hand-sewn robotic-assisted technique in the prone position is promising and maybe the simplest way to carry out thoracic anastomosis during Ivor-Lewis esophagectomy.
authors.affiliation: Esophago-gastric Surgery and Robotic Unit, Service of General and Digestive Surgery, Basurto University Hospital, Avenida Montevideo, 18, 48013, Bilbao, Spain. ismael.diezdelval@osakidetza.net.
authors.forename: Ismael
authors.initials: I
authors.lastname: Diez Del Val
authors.affiliation: Esophago-gastric Surgery and Robotic Unit, Service of General and Digestive Surgery, Basurto University Hospital, Avenida Montevideo, 18, 48013, Bilbao, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Loureiro Gonzalez
authors.affiliation: Esophago-gastric Surgery Unit, Service of General and Digestive Surgery, Donostia University Hospital, Paseo Dr Begiristain, 115, 20080, san sebastian, Spain.
authors.forename: Santiago
authors.initials: S
authors.lastname: Larburu Etxaniz
authors.affiliation: Esophago-gastric Surgery and Robotic Unit, Service of General and Digestive Surgery, Basurto University Hospital, Avenida Montevideo, 18, 48013, Bilbao, Spain.
authors.forename: Julen
authors.initials: J
authors.lastname: Barrenetxea Asua
authors.affiliation: Service of General and Digestive Surgery, Basurto University Hospital, Avenida Montevideo, 18, 48013, Bilbao, Spain.
authors.forename: Saioa
authors.initials: S
authors.lastname: Leturio Fernandez
authors.affiliation: Service of General and Digestive Surgery, Basurto University Hospital, Avenida Montevideo, 18, 48013, Bilbao, Spain.
authors.forename: Sandra
authors.initials: S
authors.lastname: Ruiz Carballo
authors.affiliation: Service of General and Digestive Surgery, Basurto University Hospital, Avenida Montevideo, 18, 48013, Bilbao, Spain.
authors.forename: Eider
authors.initials: E
authors.lastname: Etxebarria Beitia
authors.affiliation: Service of General and Digestive Surgery, Basurto University Hospital, Avenida Montevideo, 18, 48013, Bilbao, Spain.
authors.forename: Patricia
authors.initials: P
authors.lastname: Perez de Villarreal
authors.affiliation: Service of General and Digestive Surgery, Basurto University Hospital, Avenida Montevideo, 18, 48013, Bilbao, Spain.
authors.forename: Lorena
authors.initials: L
authors.lastname: Hierro-Olabarria
authors.affiliation: Esophago-gastric Surgery and Robotic Unit, Service of General and Digestive Surgery, Basurto University Hospital, Avenida Montevideo, 18, 48013, Bilbao, Spain.
authors.forename: Jose Esteban
authors.initials: JE
authors.lastname: Bilbao Axpe
authors.affiliation: Service of General and Digestive Surgery, Basurto University Hospital, Avenida Montevideo, 18, 48013, Bilbao, Spain.
authors.forename: Jaime Jesus
authors.initials: JJ
authors.lastname: Mendez Martin
keywords: Esophagectomy; Esophagus; Ivor-Lewis; Minimally invasive esophagectomy; Robotic surgery; Transhiatal esophagectomy