Top

Langenbeck's Archives of Surgery

Published in:

01-08-2006 | New Surgical Horizons

Robotic-assisted transhiatal esophagectomy

Authors: Carsten N. Gutt, Vasile V. Bintintan, Jörg Köninger, Beat P. Müller-Stich, Michael Reiter, Markus W. Büchler

Published in: Langenbeck's Archives of Surgery | Issue 4/2006

Abstract

Background

Despite its reduced aggressiveness and excellent results obtained in certain diseases, minimally invasive surgery did not manage to significantly lower the risks of esophageal resections. Further advances in technology led to the creation of robotic systems with their unique maneuverability of the instruments and exceptional view on the operative field, thus setting the prerequisites for performance in complex surgical procedures and offering new possibilities to a disease notorious for its dismal prognosis.

Materials and methods

The robotic-assisted transhiatal esophagectomy technique was used in a patient with squamous cell carcinoma of the lower esophagus that had high medical risk for surgical therapy.

Results

Esophageal resection and reconstruction were possible through a robotic-assisted minimally invasive transhiatal approach. There were no intraoperative incidents, blood loss was minimal, and lymph node dissection and removal was possible during the procedure. Early ambulation and conservative treatment of the mild complications that occurred offered a favorable postoperative outcome.

Conclusion

The robotic-assisted transhiatal esophagectomy technique is feasible and safe. Complex procedures become less technically demanding with the help of the robotic system and, thus, the minimally invasive approach can be offered for the benefit of selected patients. Further studies are required to confirm these observations and to establish the role of this procedure in the future.

Earlam R, Cunha-Melo JR (1980) Oesophageal squamous cell carcinoma: I. A critical review of surgery. Br J Surg 67:381–390PubMedCrossRef

Allum WH, Roginski C, Fieldig CW et al (1986) Adenocarcinoma of the cardia: a ten year regional review. World J Surg 10:462–467PubMedCrossRef

Siewert JR (1988) Achievements of tumor surgery in tumors of the esophagus. Langenbecks Arch Chir Suppl 2:119–126

Millikan KW, Silverstein J, Hart V, Blair K, Bines S, Roberts J, Doolas A (1995) A 15-year review of esophagectomy for carcinoma of the esophagus and cardia. Arch Surg 130:617–624PubMed

Orringer MB, Sloan H (1978) Esophagectomy without thoracotomy. J Thorac Cardiovasc Surg 76:643–654PubMed

Cuschieri A, Shimi S, Banting S (1992) Endoscopic oesophagectomy through a right thoracoscopic approach. J R Coll Surg Edinb 37:7–11PubMed

Kawahara K, Maekawa T, Okabayashi K, Hideshima T, Shiraishi T, Yoshinaga Y, Shirakusa T (1999) Video-assisted thoracoscopic esophagectomy for esophageal cancer. Surg Endosc 13:218–223PubMedCrossRef

Smithers BM, Gotley DC, McEwan D, Martin I, Bessell J, Doyle L (2001) Thoracoscopic mobilization of the esophagus: a 6 year experience. Surg Endosc 15:176–182PubMedCrossRef

DePaula AL, Hashiba K, Ferreira EA, de Paula RA, Grecco E (1995) Laparoscopic transhiatal esophagectomy with esophagogastroplasty. Surg Laparosc Endosc 5:1–5PubMed

10.

Swanstrom L, Hansen P (1997) Laparoscopic total esophagectomy. Arch Surg 132:943–949PubMed

11.

Nguyen NT, Schauer PR, Luketich JD (1999) Combined laparoscopic and thoracoscopic approach to esophagectomy. J Am Coll Surg 188:328–332PubMedCrossRef

12.

Luketich JD, Alvelo-Rivera M, Buenaventura PO, Christie NA, McCaughan JS, Litle VR, Schauer PR, Close JM, Fernando HC (2003) Minimally invasive esophagectomy: outcomes in 222 patients. Ann Surg 238:486–494PubMed

13.

Ballanthyne GH (2002) Robotic surgery, telerobotic surgery, telepresence and telementoring. Surg Endosc 16:1389–1402CrossRef

14.

Melvin W, Needleman B, Krause K, Schneider C, Wolf R, Michler R, Ellison E (2002) Computer-enhanced robotic telesurgery. Surg Endosc 16:1790–1792PubMedCrossRef

15.

Talamini M, Chapman S, Horgan S, Melvin W (2003) A prospective analysis of 211 robotic-assisted surgical procedures. Surg Endosc 17:1521–1524PubMedCrossRef

16.

Giulianotti P, Coratti A, Angelini M, Sbrana F, Cecconi S, Balestracci T, Caravaglios G (2003) Robotics in general surgery. Arch Surg 138:777–784PubMedCrossRef

17.

Sihvo EI, Luostarinen ME, Salo JA (2004) Fate of patients with adenocarcinoma of the esophagus and the esophagogastric junction: a population-based analysis. Am J Gastroenterol 99:419–424PubMedCrossRef

18.

Whooley BP, Law S, Murthy SC, Alexandrou A, Wong J (2001) Analysis of reduced death and complication rates after esophageal resection. Ann Surg 233:338–344PubMedCrossRef

19.

Nagawa H, Kobori O, Muto T (1994) Prediction of pulmonary complications after transthoracic oesophagectomy. Br J Surg 81:860–862PubMedCrossRef

20.

Ferguson MK, Durkin AE (2002) Preoperative prediction of the risk of pulmonary complications after esophagectomy for cancer. J Thorac Cardiovasc Surg 123:661–669PubMedCrossRef

21.

Karl RC, Schreiber R, Boulware D, Baker S, Coppola D (2000) Factors affecting morbidity, mortality, and survival in patients undergoing Ivor Lewis esophagogastrectomy. Ann Surg 231:635–643PubMedCrossRef

22.

Orringer MB, Marshall B, Iannettoni MD (2001) Transhiatal esophagectomy for treatment of benign and malignant esophageal disease. World J Surg 25:196–203PubMedCrossRef

23.

Hulscher JBF, Tijssen JBP, Obertop H et al (2001) Transthoracic versus transhiatal resection for carcinoma of the esophagus: a meta-analysis. Ann Thorac Surg 72:306–313PubMedCrossRef

24.

Gossot D, Cattan P, Fritsch S, Halimi B, Sarfati E, Celerier M (1995) Can the morbidity of esophagectomy be reduced by the thoracoscopic approach? Surg Endosc 9:1113–1115PubMedCrossRef

25.

Robertson GSM, Lloyd DM, Wicks ACB, Veitch PS (1996) No obvious advantages for thoracoscopic two-stage oesophagectomy. Br J Surg 83:675–678PubMedCrossRef

26.

Nguyen NT, Roberts P, Follette DM, Rivers R, Wolfe BM (2003) Thoracoscopic and laparoscopic esophagectomy for benign and malignant disease: lessons learned from 46 consecutive procedures. J Am Coll Surg 197:902–913PubMedCrossRef

27.

Fernando HC, Luketich JD, Buenaventura PO, Perry Y, Christie NA (2002) Outcomes of minimally invasive esophagectomy (MIE) for high-grade dysplasia of the esophagus. Eur J Cardiothorac Surg 22:1–6PubMedCrossRef

28.

Endo M, Yoshino K, Kawano T, Nagai K, Inoue H (2000) Clinicopathologic analysis of lymph node metastasis in surgically resected superficial cancer of the thoracic esophagus. Dis Esophagus 13:125–129PubMedCrossRef

29.

Ryan P, McCarthy S, Kelly J, Collins JK, Dunne C, Grogan L, Breathnach O, Shanahan F, Carey PD, Walsh TN, O’Sullivan GC (2004) Prevalence of bone marrow micrometastases in esophagogastric cancer patients with and without neoadjuvant chemoradiotherapy. J Surg Res. 117:121–126PubMedCrossRef

30.

Bonavina L, Incarbone R, Bona D, Peracchia A (2004) Esophagectomy via laparoscopy and transmediastinal endodissection. J Laparoendosc Adv Surg Tech A 14:13–16PubMedCrossRef

31.

Bumm R, Feussner H, Bartels H, Stein H, Dittler H, Höfler H, Siewert R (1997) Radical transhiatal esophagectomy with two-field lymphadenectomy and endodissection for distal esophageal adenocarcinoma. World J Surg 2:822–831

32.

Espat J, Jacobsen G, Horgan S, Donahue P (2005) Minimally invasive treatment of esophageal cancer: laparoscopic staging to robotic esophagectomy. Cancer J 11:10–17PubMedCrossRef

33.

Horgan S, Berger R, Elli E, Espat J (2003) Robotic-assisted minimally invasive transhiatal esophagectomy. Am Surg 69:624–626PubMed

34.

Bodner J, Wykypiel H, Wetscher G, Schmid T (2004) First experiences with the da Vinci operating robot in thoracic surgery. Eur J Cardiothorac Surg 2004:844–851CrossRef

35.

Bodner JC, Zitt M, Ott H, Wetscher GJ, Wykypiel H, Lucciarini P, Schmid T (2005) Robotic-assisted thoracoscopic surgery (RATS) for benign and malignant esophageal tumors. Ann Thorac Surg 80:1202–1206PubMedCrossRef

36.

Ruurda JP, Draaisma WA, van Hillegersberg R, Borel Rinkes IH, Gooszen HG, Janssen LW, Simmermacher RK, Broeders IA (2005) Robot-assisted endoscopic surgery: a four-year single-center experience. Dig Surg 22:313–320PubMedCrossRef

Title: Robotic-assisted transhiatal esophagectomy
Authors: Carsten N. Gutt
Vasile V. Bintintan
Jörg Köninger
Beat P. Müller-Stich
Michael Reiter
Markus W. Büchler
Publication date: 01-08-2006
Publisher: Springer-Verlag
Published in: Langenbeck's Archives of Surgery / Issue 4/2006
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-006-0055-3

At a glance: The STEP trials

Springer Medicine

Robotic-assisted transhiatal esophagectomy

Abstract

Background

Materials and methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Materials and methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 4/2006

Randomized trial of the efficacy of adjuvant chemotherapy for colon cancer with combination therapy incorporating the oral pyrimidine 1-hexylcarbamoyl-5-fluorouracil

Comments on the publication “A comparative analysis of phenotype expression in human osteoblasts from heterotopic ossification and normal bone”

The treatment of intrahepatic calculosis by applying helix hydro-jet lithotripsy under video choledochoscope: a report of 30 cases

Evaluation of the McPeek postoperative outcome score in three trials

A comparative analysis of phenotype expression in human osteoblasts from heterotopic ossification and normal bone

Predictive factors of liver injury in blunt multiple trauma