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Objective: Robotic esophagectomy for esophageal cancer in the prone position under pneumothorax has a number of advantages over thoracoscopic esophagectomy.
Methods: Four patients performed robot-assisted thoracoscopic esophagectomy in the prone position using 3-arm standard da Vinci surgical system (IS 1200). The procedure started with the patient prone undergoing single lung ventilation, and 4 trocars were placed in the 2nd, 4th, 6th right intercostal space on the posterior axillar line. One more ports were placed in the 4th intercostal space on the mid axillar line for the service port. CO2 insufflation was used to maintain an insufflation pressure of 6-10 mmHg before introducing the da Vinci system endoscope. The intrathoracic esophagus was dissected, and lymphadenectomy around the both recurrent nerves and the inferior mediastinal were performed. Subsequently the patient was placed in supine position and 5 abdominal trocars were placed, stomach mobilization, gastric tube creation and celiac lymphadenectomy are performed by laparoscopic maneuver. The esogastric anastomosis finally performed via left cervicotomy.
Results: All thoracoscopic procedures were completed with a robot-assisted technique. Average robot console time was 450 minutes, and average number of dissected mediastinal nodes was 45. There was no incidence of pneumonia or 30-day mortality. Major complications included anastomotic leakage in 3 patients, and transient vocal cord palsy was occur in 2 patients.
Conclusions: Robotic-assisted thoracoscopic esophagectomy in the prone position is technically feasible and safe and was oncologically acceptable. Operating time, blood loss and pulmonary complications might decrease with further experience.