Initial introduction of robot-assisted, minimally invasive esophagectomy using the microanatomy-based concept in the upp
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and Other Interventional Techniques
Initial introduction of robot‑assisted, minimally invasive esophagectomy using the microanatomy‑based concept in the upper mediastinum Yasuhiro Shirakawa1,2 · Kazuhiro Noma1 · Tomoyoshi Kunitomo1 · Masashi Hashimoto1 · Naoaki Maeda1 · Shunsuke Tanabe1 · Kazufumi Sakurama1 · Toshiyoshi Fujiwara1 Received: 8 July 2020 / Accepted: 4 November 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background We have recently standardized upper mediastinal lymph node dissection (UMLND) using a microanatomy-based concept in thoracoscopic esophagectomy in the prone position (TEPP), and introduced robot-assisted minimally invasive esophagectomy (RAMIE) using the same concept as in TEPP while aiming at solo surgery. The purpose of this study was to investigate the outcomes of RAMIE using the microanatomy-based concept in the initial introduction phase. Methods We have performed more than 500 TEPP procedures as minimally invasive esophagectomy (MIE). After performing about 400 cases of MIE, we established a microanatomy-based standardization of UMLND. In October 2018, we introduced RAMIE, and have performed 75 procedures in 20 months. Two groups were analyzed: a group after microanatomy-based standardization in TEPP (100 cases after completing 400 cases of TEPP) and a RAMIE group (75 cases). Finally, 51 paired cases were matched using a propensity score. Furthermore, the change in postoperative short-term outcome for RAMIE in the initial introduction phase was analyzed. Results Although there were no significant differences between the two groups in the number of upper mediastinal lymph nodes dissected, there was a significant decrease (P = 0.036) in intraoperative blood loss volume with RAMIE, representing a definite benefit for patients. The thoracoscopic operative time for RAMIE decreased by almost 100 min following less than 50 cases of experience, reaching the same level as that for recent TEPP, but with only one-tenth the operator experience. There were no significant differences in the total postoperative morbidity rate including the recurrent laryngeal nerve palsy rate. Conclusion RAMIE has been introduced safely and smoothly using the microanatomy-based concept established in TEPP. Keywords Esophageal cancer · Microanatomy · Robot-assisted minimally invasive esophagectomy · Thoracoscopic esophagectomy · Upper mediastinal lymph node dissection Esophageal cancer is the sixth leading cause of death from malignancy and is common in Asian countries including Japan, with squamous cell carcinoma seen in the majority of these countries. Esophageal cancer tends to metastasize easily and to have low 5-year survival rates (ranging from 15–25%) [1]. Radical esophagectomy with extended * Yasuhiro Shirakawa [email protected]‑u.ac.jp 1
Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, 7‑33 Mot
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