Robotic-assisted Ivor Lewis Esophagectomy With Totally Robotic Intrathoracic/intracorporeal Anastomosis
Matthew D. Stanley, MD, Manu S. Sancheti, MD.
Emory University, Atlanta, GA, USA.
Background
The rapid adoption of robotic-assisted thoracic surgery has led to increased interest in totally robotic-assisted procedures. Previously, robotic-assisted Ivor Lewis esophagectomy required the creation of a mini-thoracotomy and introduction of thoracoscopic instrumentation and staplers.
Methods
We present a totally robotic-assisted Ivor Lewis esophagectomy with intrathoracic anastomosis creation and intracorporeal suturing.
Results
After positioning in the left lateral decubitus position, five ports are placed (four robotic and one assistant) in standard fashion. After complete mobilization, the esophagus is divided proximally at the level of the azygos vein using a robotic-assisted stapler. Next, the conduit and specimen are delivered into the chest ensuring to maintain the correct orientation. Completion of the conduit is accomplished using a robotic-assisted stapler and the specimen can be removed from the thoracic cavity. The proximal esophageal staple line is removed using robotic-assisted monopolar scissors and can be sent as a proximal margin. After gastrostomy creation, a robotic-assisted stapler is used to create a side-to-side, functional end-to-end gastroesophageal anastomosis. Two corner retraction sutures are placed at the lateral edges of the common anterior opening to facilitate intracorporeal suturing. The nasogastric tube is passed distally, and the anterior common opening is closed in two-layers using barbed suture. The corner retraction sutures are tied, and any gaps can be filled with interrupted sutures. Finally, the integrity of the anastomosis is checked with an air leak test
Conclusions
We demonstrate a safe, efficient and reproducible method for creation of an totally robotic-assisted Ivor Lewis esophagogastric anastomosis.
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