Usefulness of robot-assisted thoracoscopic esophagectomy
- 216 Downloads
We started robot-assisted thoracoscopic esophagectomy using the da Vinci surgical system from June 2010 and operated on 30 cases by December 2013. Herein, we examined the usefulness of robot-assisted thoracoscopic esophagectomy and compared it with conventional esophagectomy by right thoracotomy.
Patients requiring an invasion depth of up to the muscularis propria with preoperative diagnosis were considered for surgical adaptation, excluding bulky lymph node metastasis or salvage surgery cases. The outcomes of 30 patients who underwent robot-assisted surgery (robot group) and 30 patients who underwent conventional esophagectomy by right thoracotomy (thoracotomy group) up to December 2013 were retrospectively examined. Five ports were used in the robot-assisted thoracoscopic esophagectomy: 3rd intercostal (da Vinci right arm), 6th intercostal (da Vinci camera), 9th intercostal (da Vinci left arm), 4th and 8th intercostals (for assistance).
There was no significant difference in patient characteristics. Robot group/right thoracotomy group: Operation time, 563/398 min; thoracic procedure bleeding volume, 21/135 ml; number of thoracic lymph node radical dissections, 25/23. Postoperative complications were recurrent nerve paralysis, 16.7/16.7%; pneumonia, 6.7%/10.0%; anastomotic leakage, 10.0/20.0%; surgical site infection, 0/10.0%; hospitalization, 17/30 days. For the robot group, the operation time was significantly longer, but the amount of intraoperative bleeding and postoperative hospitalization were significantly reduced.
Robot-assisted thoracoscopic esophagectomy enables delicate surgical procedures owing to the 3D effect of the field of view and articulated forceps of the da Vinci. This procedure reduces bleeding and postoperative hospitalization and is less invasive than conventional esophagectomy by right thoracotomy.
KeywordsDa Vinci Robotic Esophagectomy Minimally invasive surgery
We thank Dr. Edward Barroga (http://orcid.org/0000-0002-8920-2607), Associate Professor and Senior Editor of Tokyo Medical University for reviewing and editing the manuscript.
Compliance with ethical standards
Conflict of interest
The authors have no conflicts of interest associated with this study.
- 7.Suda K, Ishii Y, Kawamura Y, Inaba K, Kanaya S, Teramukai S, et al. Robot-assisted thoracoscopic lymphadenectomy along the left recurrent laryngeal nerve for esophageal squamous cell carcinoma in the prone position: technical report and short-term outcomes. World J Surg. 2012; 36:1608–16.CrossRefGoogle Scholar
- 8.Palanivelu C, Prakash A, Senthilkumar R, Senthilnathan P, Parthasarathi R, Rajan PS, et al. Minimally invasive esophagectomy: thoracoscopic mobilization of the esophagus and mediastinal lymphadenectomy in prone position—experience of 130 patients. J Am Coll Surg. 2006;203:7–16.CrossRefPubMedGoogle Scholar
- 10.Watson TJ. Robotic esophagectomy: is it an advance and what is the future? Ann Thorac Cardiovasc Surg. 2008;85:s757–9.Google Scholar
- 13.van der Sluis PC, Ruurda JP, van der Horst S, Verhage RJ, Besselink GH, Prins JD, et al. Robot-assisted minimally invasive thoraco-laparoscopic esophagectomy versus open transthoracic esophagectomy for resectable esophageal cancer, a randomized controlled trial (ROBOT trial). Trials. 2012;13:230.CrossRefPubMedPubMedCentralGoogle Scholar