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International Society For Minimally Invasive Cardiothoracic Surgery

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Robot Assisted Mckeown Esophagectomy With Robot Assisted Feeding Jejunostomy
Farhan Nadeem, Roman Petrov, Charles Bakhos, Abbas Abbas
Temple University Hospital, Philadelphia, PA, USA

BACKGROUND:
Minimally Invasive esophagectomy has been shown to have less complication rates without sacrificing oncological outcomes. Robot assisted esophagectomy is an attractive option to perform esophagectomy as it provides better visualization of the mediastinum thus enabling meticulous dissection from diaphragm to thoracic inlet. Traditional esophagectomy techniques (i.e Ivor-Lewis, McKeown and transhiatal) have been translated into robotic approaches with selective adaptation depending on surgeon and institution preferences playing a major role in addition to patient factors. Even among the three traditional techniques, diversity exists in terms of approaching thoracic cavity before abdomen, sequence of steps, sewn vs stapled anastomosis. We describe our technique to perform robot assisted McKeown esophagectomy.
METHODS: 73 M with 12cm adenocarcinoma of distal esophagus (uT3N1) on EUS presented after induction chemoradiotherapy for surgical resection.
RESULTS: The technical aspects of the procedure are described in the video thoroughly.
CONCLUSION: Robot assisted McKeown esophagectomy is feasible and safe approach even after chemoradiotherapy. Using indocyanine green provides important information about perfusion of the gastric conduit. Robotic platform also helps in performance of feeding jejunostomy both safely and efficiently.


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