Robotic esophagectomy: how I do it?

Abstract

Compared to the open approach, minimally invasive esophagectomy (MIE) offers several advantages including smaller incisions with decreased pain, improved cosmesis, and earlier return of the patient to baseline function. Robotic-assisted minimally invasive esophagectomy (RAMIE) builds on standard MIE by offering three-dimensional visualization, better instrument articulation, tremor filtration, and superior ergonomics, all of which facilitate technical precision and surgeon comfort. An evolving literature demonstrates that when performed by experienced surgeons, RAMIE leads to improved perioperative outcomes with long-term oncologic equivalency to open approaches, and may offer advantages compared to traditional MIE. This review focuses on the key steps of performing 3-field McKeown, 2-field Ivor Lewis, and transhiatal robotic esophagectomies, data regarding the short- and long-term outcomes, and a brief overview of upcoming trials comparing RAMIE with MIE.

Keywords

Esophagectomy / robotic / minimally invasive esophagectomy

References

[1] Biere SS,Maas KW,Rosman C.Minimally invasive versus open oesophagectomy for patients with oesophageal cancer: a multicentre, open-label, randomised controlled trial..Lancet2012;379:1887-92

[2] Puntambekar S,Kumar S,Agarwal G.Robotic transthoracic esophagectomy..BMC Surg2015;15:47 PMCID:PMC4417322

[3] Safranek PM,Booth MI.Review of open and minimal access approaches to oesophagectomy for cancer..Br J Surg2010;97:1845-53

[4] Straatman J,Cuesta MA,Roig Garcia J.Minimally invasive versus open esophageal resection: three-year follow-up of the previously reported randomized controlled trial: the TIME trial..Ann Surg2017;266:232-6

[5] van der Sluis PC,May AM,Brosens LAA.Robot-assisted minimally invasive thoracolaparoscopic esophagectomy versus open transthoracic esophagectomy for resectable esophageal cancer: a randomized controlled trial..Ann Surg2019;269:621-30

[6] Collard JM,Otte JB.En bloc and standard esophagectomies by thoracoscopy..Ann Thorac Surg1993;56:675-9

[7] Melvin WS,Krause KR,Wolf RK.Computer-enhanced robotic telesurgery. Initial experience in foregut surgery..Surg Endosc2002;16:1790-2

[8] Horgan S,Elli EF.Robotic-assisted minimally invasive transhiatal esophagectomy..Am Surg2003;69:624-6

[9] Kernstine KH,Karimi M,Campos JH.The robotic, 2-stage, 3-field esophagolymphadenectomy..J Thorac Cardiovasc Surg2004;127:1847-9

[10] van Hillegersberg R,Draaisma WA,Giezeman MJ.First experience with robot-assisted thoracoscopic esophagolymphadenectomy for esophageal cancer..Surg Endosc2006;20:1435-9

[11] Kernstine KH,Shamoun DM.The first series of completely robotic esophagectomies with three-field lymphadenectomy: initial experience..Surg Endosc2007;21:2285-92

[12] Dunn DH,Morphew JA,Krueger JL.Robot-assisted transhiatal esophagectomy: a 3-year single-center experience..Dis Esophagus2013;26:159-66

[13] Cerfolio RJ,Hawn MT.Robotic esophagectomy for cancer: early results and lessons learned..Semin Thorac Cardiovasc Surg2016;28:160-9

[14] He H,Wang Z,Chen N.Short-term outcomes of robot-assisted minimally invasive esophagectomy for esophageal cancer: a propensity score matched analysis..J Cardiothorac Surg2018;13:52 PMCID:PMC5967100

[15] Tagkalos E,Hoppe-Lotichius M,Babic B.Robot-assisted minimally invasive esophagectomy (RAMIE) compared to conventional minimally invasive esophagectomy (MIE) for esophageal cancer: a propensity-matched analysis..Dis Esophagus2020;33:doz060

[16] van der Sluis PC,van der Horst S,van Hillegersberg R.Learning curve for robot-assisted minimally invasive thoracoscopic esophagectomy: results from 312 cases..Ann Thorac Surg2018;106:264-71

[17] Ladak F,Switzer N,Tian C.Indocyanine green for the prevention of anastomotic leaks following esophagectomy: a meta-analysis..Surg Endosc2019;33:384-94

[18] Okusanya O,Luketich JD.Intraoperative near infrared fluorescence imaging for the assessment of the gastric conduit..J Thorac Dis2019;11:S750-4 PMCID:PMC6503263

[19] Plat VD,Schoonmade LJ,van der Peet DL.Implementation of robot-assisted Ivor Lewis procedure: Robotic hand-sewn, linear or circular technique?.Am J Surg2020;220:62-8

[20] Zhang H,Zheng Y,Wang F.Robotic side-to-side and end-to-side stapled esophagogastric anastomosis of ivor lewis esophagectomy for cancer..World J Surg2019;43:3074-82

[21] Sarkaria IS,Goldman DA,Tan KS.Early quality of life outcomes after robotic-assisted minimally invasive and open esophagectomy..Ann Thorac Surg2019;108:920-8 PMCID:PMC6774254

[22] van der Sluis PC,Hadzijusufovic E,Uzun E.Robot-assisted minimally invasive esophagectomy with intrathoracic anastomosis (Ivor Lewis): promising results in 100 consecutive patients (the European experience)..J Gastrointest Surg2020;

[23] Na KJ,Park IK,Kang CH.Outcomes after total robotic esophagectomy for esophageal cancer: a propensity-matched comparison with hybrid robotic esophagectomy..J Thorac Dis2019;11:5310-20 PMCID:PMC6988082

[24] Oshikiri T,Harada H,Oyama M.A new method (the “Bascule method”) for lymphadenectomy along the left recurrent laryngeal nerve during prone esophagectomy for esophageal cancer..Surg Endosc2015;29:2442-50

[25] Chao YK,Wen YW,Park SY.Robotic-assisted esophagectomy vs video-assisted thoracoscopic esophagectomy (REVATE): study protocol for a randomized controlled trial..Trials2019;20:346 PMCID:PMC6558787

[26] Chao YK,Chuang WY.Transition from video-assisted thoracoscopic to robotic esophagectomy: a single surgeon’s experience..Dis Esophagus2020;33:doz033

[27] Chen J,Zhang X,Tan Z.Comparisons of short-term outcomes between robot-assisted and thoraco-laparoscopic esophagectomy with extended two-field lymph node dissection for resectable thoracic esophageal squamous cell carcinoma..J Thorac Dis2019;11:3874-80 PMCID:PMC6790445

[28] Konstantinidis IT,Woo Y,Melstrom K.Trends and outcomes of robotic surgery for gastrointestinal (GI) cancers in the USA: maintaining perioperative and oncologic safety..Surg Endosc2019;

[29] Sheetz KH,Dimick JB.Trends in the adoption of robotic surgery for common surgical procedures..JAMA Netw Open2020;3:e1918911 PMCID:PMC6991252

[30] Yang Y,Li B,Sun Y.Robot-assisted esophagectomy (RAE) versus conventional minimally invasive esophagectomy (MIE) for resectable esophageal squamous cell carcinoma: protocol for a multicenter prospective randomized controlled trial (RAMIE trial, robot-assisted minimally invasive Esophagectomy)..BMC Cancer2019;19:608 PMCID:PMC6587242