Robot-Assisted Minimally Invasive McKeown Esophagectomy with a Four-Arm Platform: Technique and Early Experience
Minimally Invasive Esophagectomy (MIE) is becoming a standard surgical method
for treating esophageal cancer in Asia. Its outcomes are comparable to those of open surgery.
Furthermore, MIE has fewer pulmonary complications and less pain.
The da Vinci robotic surgical system was granted United States Food and Drug Administration approval in July 2000; robotic techniques are increasingly being adopted in America for many types of laparoscopic surgery.
The benefits of a robotic approach are three-dimensional vision; camera stability; instruments with a high degree of dexterity, precision, and control; and a 3rd arm for self-assistance.
Studies3,4 have described a robotic approach to esophageal surgery when treating
achalasia and hiatal hernia; however, experience with Robot-Assisted MIE is still limited.
Several series5-10 have reported variable hybrid approaches for RAMIE, but only two11,12 describe its surgical details and outcomes.
We report our first experience of complete RAMIE with
a four-arm robotic platform, and describe technical modifications
made to overcome specific challenges.
Short-term surgical
outcomes and complications encountered are discussed.
We enrolled 11 patients with esophageal cancer. All
had undergone a RAMIME using a combined thoracoscopic
and laparoscopic approach.
All patients underwent preoperative
staging and evaluation, which included a medical history and
physical examination, an upper gastrointestinal endoscopy and
biopsy, a bone scan, computed tomography of the chest, and
abdominal and endoscopic ultrasound evaluations. Patients
with T2 tumors or greater, or nodal involvement, or both, were
referred for induction chemoradiation therapy.
Gastro Open J. 2015; 1(1): 15-22. doi: 10.17140/GOJ-1-105
