Modified Intrathoracic Esophagogastrostomy with Minimally Invasive Robot-Assisted Ivor-Lewis Esophagectomy for Cancer

2018 ◽  
Vol 36 (3) ◽  
pp. 218-225 ◽  
Author(s):  
Wen-Ping Wang ◽  
Long-Qi Chen ◽  
Han-Lu Zhang ◽  
Yu-Shang Yang ◽  
Song-Lin He ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Circular Stapler ◽  
Purse String Suture ◽  
Robot Assisted ◽  
Purse String ◽  
Ivor Lewis ◽  
Intrathoracic Anastomosis ◽  
Ivor Lewis Esophagectomy ◽  
Estimated Blood Loss ◽  
Esophagectomy For Cancer

Background: Intrathoracic esophagogastrostomy plays an important role in minimally invasive Ivor-Lewis esophagectomy for cancer. Intrathoracic anastomosis with robot-assisted Ivor-Lewis esophagectomy (RAILE) includes hand-sewn and circular stapler methods, which remain technically challenging. In this study, we modified the techniques for intrathoracic anastomosis at RAILE, in order to simplify the complex procedures. Methods: “Side-insertion” technique was used for anvil placement and purse string suture for intrathoracic anastomosis at RAILE. Medical records for consecutive patients who had undergone robot-assisted minimally invasive Ivor-Lewis esophagectomy for cancer between January 2015 and June 2018 were analyzed. Results: A total of consecutive 31 patients were enrolled. There was no conversion to open thoracotomy in this cohort. Mean operation duration in the robotic group was 387.4 ± 68.2 min. Median estimated blood loss was 110 mL (range 50–400 mL). Two patients (6.5%) had postoperative anastomotic leak. No postoperative reoperation was needed and there were no mortality. Six patients (19.4%) had anastomotic stricture and 2 patients of them needed endoscopic dilation. Conclusion: RAILE is safe and feasible. Our modified procedure highlighting the “side-insertion” method may simplify the process of intrathoracic anvil placement and purse string suture for anastomosis at RAILE.

PS01.224: MODIFIED INTRATHORACIC ESOPHAGOGASTROSTOMY AT MINIMALLY INVASIVE ROBOT-ASSISTED IVOR-LEWIS ESOPHAGECTOMY FOR CANCER

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 113-114
Author(s):  
Wen-Ping Wang ◽  
Long-Qi Chen ◽  
Han-Lu Zhang ◽  
Yu-Shang Yang ◽  
Song-Lin He ◽  
...  
Keyword(s):  
Blood Loss ◽  
Minimally Invasive ◽  
Esophagogastric Anastomosis ◽  
Purse String Suture ◽  
Robotic Group ◽  
Robot Assisted ◽  
Purse String ◽  
Ivor Lewis ◽  
Ivor Lewis Esophagectomy ◽  
Esophagectomy For Cancer

Abstract Background The intrathoracic esophagogastrostomy played important role in minimally invasive Ivor-Lewis esophagectomy for cancer. The methods of intrathoracic esophagogastric anastomosis at robot-assisted Ivor-Lewis esophagectomy mostly included hand-sewn, and circular stapler (anvil placement via OrVil system or transthoracically), which were still technically challenging. In this study, we modified the techniques of intrathoracic esophagogastric anastomosis at robot-assisted Ivor-Lewis esophagectomy for cancer, in order to seek to simplify this complicated intrathoracic procedure. Then retrospective comparison between robotic and thoracoscopic cohorts was conducted. Methods We modified techniques focused on the ‘side-insertion’ anvil placement and purse string suture of intrathoracic robot-assisted esophagogastric anastomosis. The consecutive records of patients who underwent minimally invasive Ivor-Lewis esophagectomy for cancer via robot-assistant and thoracoscopic procedures in our department between January 2015 and November 2017 were retrospectively analyzed. Results Totally 47 patients were enrolled including 20 patients (male: 17, female: 3) in robot-assisted group and 27 patients (male: 21, female: 6) in thoracoscopic group. There was no conversion to open thoracotomy in both two groups. Mean operation duration of robotic group was 412.5 ± 63.5 min, significantly higher than 363.0 ± 53.3 min in thoracoscopic group (P = 0.006). Estimated blood loss in robotic group was less than that in thoracoscopic group (107.5 ± 63.5ml vs. 188.9 ± 94.3ml, respectively, P = 0.002). One patient (5.0%) in robotic group and two patients(7.4%) in thoracoscopic group had anastomotic leak. No postoperative reoperation or mortality (in-hospital or within 30 days after surgery) occurred in both groups. Conclusion Robot-assisted Ivor-Lewis esophagectomy was safe and feasible. Our modified procedure highlighting the ‘side-insertion’ method could simplify the process of intrathoracic anvil placement and purse string suture for the robot-assisted esophagogastric anastomosis. Robot-assisted Ivor-Lewis esophagectomy was nearly equivalent to thoracoscopic Ivor-Lewis esophagectomy at short-term outcomes, except higher operation time and less blood loss. Disclosure All authors have declared no conflicts of interest.

scholarly journals Minimally invasive intrathoracic anastomosis after Ivor Lewis esophagectomy for cancer: a review of transoral or transthoracic use of staplers

2012 ◽  
Vol 26 (7) ◽  
pp. 1795-1802 ◽  
Author(s):  
K. W. Maas ◽  
S. S. A. Y. Biere ◽  
J. J. G. Scheepers ◽  
S. S. Gisbertz ◽  
V. Turrado Rodriguez ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Ivor Lewis ◽  
Intrathoracic Anastomosis ◽  
Ivor Lewis Esophagectomy ◽  
Esophagectomy For Cancer

Using the Hand-Sewn Purse-String Stapled Anastomotic Technique for Minimally Invasive Ivor Lewis Esophagectomy

2018 ◽  
Vol 67 (07) ◽  
pp. 578-584 ◽  
Author(s):  
Bicheng Zhan ◽  
Jian Chen ◽  
Shaoming Du ◽  
Yanzheng Xiong ◽  
Jian Liu
Keyword(s):  
Esophageal Cancer ◽  
Minimally Invasive ◽  
Anastomotic Stricture ◽  
Circular Stapler ◽  
Fixation Time ◽  
Purse String ◽  
Ivor Lewis ◽  
Anastomotic Technique ◽  
Open Esophagectomy ◽  
Ivor Lewis Esophagectomy

Background Minimally invasive Ivor Lewis esophagectomy (MIILE) is increasingly being used in the treatment of middle or lower esophageal cancer. Hand-sewn purse-string stapled anastomosis is a classic approach in open esophagectomy. However, this procedure is technically difficult under thoracoscopy. The hardest part is delivering the anvil into the esophageal stump. Herein, we report an approach to performing this step under thoracoscopy. Methods A total of 257 consecutive patients who underwent MIILE between April 2013 and July 2017 were analyzed retrospectively. The operator hand sewed the purse string using silk thread under thoracoscopy, and the 25-mm circular stapler was passed through the anterior axillary line at the fourth intercostal space to finish the side-to-end gastroesophageal anastomosis. Patient demographics, intraoperative data, postoperative complications were evaluated. Results The mean operative time, thoracoscopy time, and anvil fixation time was 307.0 ± 34.3, 155.4 ± 21.5, and 7.1 ± 1.6 minute, respectively. The anastomotic leak and anastomotic stricture occurred in 6.6% (17 of 257) and 3.9% (10 of 257) of patients, respectively. There was no intraoperative death; one case was death of acute respiratory distress syndrome (ARDS) for conduit gastric leakage on the 21st postoperative day. Conclusion Using the hand-sewn purse-string stapled anastomotic technique for MIILE is feasible and relatively safe in patients with middle or lower esophageal cancer.

Robot-Assisted Minimally Invasive Ivor Lewis Esophagectomy With Real-Time Perfusion Assessment

2015 ◽  
Vol 100 (3) ◽  
pp. 947-952 ◽  
Author(s):  
Arielle Hodari ◽  
Ko Un Park ◽  
Brian Lace ◽  
Athanasios Tsiouris ◽  
Zane Hammoud
Keyword(s):  
Minimally Invasive ◽  
Real Time ◽  
Robot Assisted ◽  
Ivor Lewis ◽  
Ivor Lewis Esophagectomy ◽  
Perfusion Assessment

scholarly journals Robot-assisted esophagogastric reconstruction in minimally invasive Ivor Lewis esophagectomy

2019 ◽  
Vol 11 (5) ◽  
pp. 1860-1866 ◽  
Author(s):  
Zihao Wang ◽  
Hanlu Zhang ◽  
Fuqiang Wang ◽  
Yun Wang
Keyword(s):  
Minimally Invasive ◽  
Robot Assisted ◽  
Ivor Lewis ◽  
Ivor Lewis Esophagectomy
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