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Robotic-assisted Ivor Lewis esophagectomy, a review of the technique

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Abstract

Esophageal resection is a key component of the multidisciplinary management of esophageal cancer. Robotic-assisted minimally invasive esophagectomy is gaining widespread approval amongst few centers with promising early data. There is significant variability in the operative approach utilized by different centers and this review describes, step-by-step, the operative technique at a high-volume tertiary center. The cornerstone of management is individualized surgical approach, based on patient, tumor and technical factors. Although our approach is based on aforementioned factors, our preferred approach is an Ivor Lewis esophagectomy and this review focuses on that. The procedure is broken down into three key parts, starting with an abdominal exploration and creation of the gastric conduit, placement of jejunostomy tube, moving to thoracic mobilization and creation of the side-side 6 cm stapled esophagogastric anastomosis with a final abdominal portion to assure proper positioning of the conduit and reducing redundancy. This approach is fully robotic and a side to side anastomosis facilitates the creation of a widely patent anastomosis therefore minimizing the risk of anastomotic leaks and strictures. Our experience with minimally invasive esophagectomy, as has been previously published, is associated with a 5.1% of anastomotic leak and 7.6% of anastomotic stricture. The robotic platform further optimizes this technique and helps us safely accomplish a side to side stapled anastomosis. Superior instrument dexterity in a restricted thoracic space is facilitated by intracorporeal suturing and robotic stapling. Thus, it obviates the need for a larger thoracotomy incision, which is typically needed for an EEA anastomosis, and that is traditionally associated with higher stricture rate.

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Funding

National Cancer Institute Roswell Park Cancer Institute Support Grant award number P30CA016056.

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Authors and Affiliations

  1. Department of Surgical Oncology, Roswell Park Comprehensive Cancer Center, 665 Elm Street, Buffalo, NY, 14203, USA

    Konstantinos Chouliaras, Steven Hochwald & Moshim Kukar

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  1. Konstantinos Chouliaras
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  2. Steven Hochwald
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  3. Moshim Kukar
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Correspondence to Moshim Kukar.

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After IRB approval the data was retrospectively reviewed.

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Chouliaras, K., Hochwald, S. & Kukar, M. Robotic-assisted Ivor Lewis esophagectomy, a review of the technique. Updates Surg 73, 831–838 (2021). https://doi.org/10.1007/s13304-021-01000-y

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  • DOI: https://doi.org/10.1007/s13304-021-01000-y

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