title: Preservation of replaced left hepatic artery during robotic-assisted minimally invasive esophagectomy: A case series.
abstract: OBJECTIVE
  Finding of a significant replaced left hepatic artery (RLHA) during esophagectomy is relatively rare, with an incidence of approximately 5%. Sparing of the artery may be required to avoid complications of liver ischemia. Robotic assistance during esophagectomy may provide a technically superior method of artery preservation with minimally invasive approaches.
  
  
  METHODS
  This is a retrospective case series of patients undergoing robotic-assisted minimally invasive esophagectomy (RAMIE) identified to have a significant RLHA at time of surgery.
  
  
  RESULTS
  Five patients with a significant RLHA were identified from a series of over 100 RAMIE operations. Preservation of RLHA was accomplished in all cases without need for conversion, no intra-operative complications, and no post-operative liver dysfunction. The stomach was suitable and used for conduit reconstruction in all patients.
  
  
  CONCLUSIONS
  Sparing of the RLHA during RAMIE is feasible and effective. The robotic assisted approach may obviate the need for open conversion during these complex minimally invasive operations.
authors.affiliation: University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
authors.forename: Nicholas R
authors.initials: NR
authors.lastname: Hess
authors.affiliation: Division of Thoracic Surgery, John Theurer Cancer Center, Hackensack, NJ, USA.
authors.forename: Nabil P
authors.initials: NP
authors.lastname: Rizk
authors.affiliation: Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: James D
authors.initials: JD
authors.lastname: Luketich
authors.affiliation: Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Inderpal S
authors.initials: IS
authors.lastname: Sarkaria
mesh_terms: D000368:Aged; D004938:Esophageal Neoplasms / Q000175:diagnosis / Q000601:surgery*; D016629:Esophagectomy / Q000295:instrumentation* / Q000379:methods; D004947:Esophagus / Q000601:surgery*; D005260:Female; D006499:Hepatic Artery / Q000601:surgery*; D006801:Humans; D015994:Incidence; D008099:Liver / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation* / Q000379:methods; D011379:Prognosis; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures; D013270:Stomach / Q000601:surgery
keywords: Robotic; esophagectomy; minimally invasive; replaced left hepatic artery