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Robotic Ivor Lewis Esophagectomy With Endoloop-assisted Right Chest Anastomosis
M. Jawad Latif, Manzar Abbas, Kostantinos Poulikidis, Faiz Bhora.
Hackensack Meridian JFK University Medical Center, Hackensack Meridian School of Medicine, Edison, NJ, USA.
BACKGROUND: Robotic-assisted minimally invasive esophagectomy (RAMIE) is increasingly adopted for esophageal cancer resection. However, intrathoracic anastomosis remains technically demanding, characterized by significant procedural variability and a steep learning curve. We present a simplified technique for thoracic anastomosis that eliminates the need for complex, operator-dependent intracorporeal suturing.
METHODS: We report a series of six patients who underwent total port RAMIE. The right-sided intrathoracic anastomosis was created using a 29 mm circular stapler. Crucially, an Endoloop was utilized to secure the anvil, facilitating a standardized and sutureless technical approach.
RESULTS: All procedures were completed successfully without intraoperative complications. Postoperative day (POD) 3 CT esophagograms confirmed no leaks, allowing for immediate initiation of clear liquid diet. Patients were discharged home on a full liquid diet by POD 5-7. No anastomotic leaks, strictures, or 90-day complications were observed in this limited series.
CONCLUSIONS: The Endoloop-assisted circular stapled technique is reproducible, teachable, and efficient. By eliminating the requirement for intracorporeal suturing, this approach standardizes the anastomosis, reduces operative time, and may lower the technical barrier for surgeon adoption.
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