Download PDF
Thorac Cardiovasc Surg 2021; 69(03): 198-203
DOI: 10.1055/s-0040-1716323
Original Thoracic

Transcervical (SP) and Transhiatal DaVinci Robotic Esophagectomy: A Cadaveric Study

Pieter van der Sluis
1   Department of General-, Visceral- and Transplant Surgery, Universitaetsmedizin Mainz, Mainz, Germany
,
Jan-Hendrik Egberts
2   Department for General, Visceral-, Thoracic-, Transplantation-, and Pediatric Surgery, Kurt Semm Center for Minimal Invasive and Robotic Surgery, University Hospital Schleswig Holstein, Campus Kiel, Kiel, Germany
,
Hubert Stein
3   Intuitive Surgical Inc., Sunnyvale, California, United States
,
Rubens Sallum
4   Department of Gastroenterology, Digestive Surgery Division, Sao Paulo University, Sao Paulo, Brazil
,
Richard van Hillegersberg
5   Department of Gastrointestinal Surgical Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
,
Peter P. Grimminger 
1   Department of General-, Visceral- and Transplant Surgery, Universitaetsmedizin Mainz, Mainz, Germany
› Author Affiliations
› Further Information
    Permissions and Reprints All articles of this category

Abstract

Background This is a preclinical cadaveric study to investigate the feasibility of a fully robotic McKeown esophagectomy in simultaneous rendezvous technique using the DaVinci X for transhiatal dissection and the DaVinci single port (SP) for transcervical dissection.

Methods Two transcervical esophagectomies with the DaVinci SP surgical system were performed as training procedures. In the third transcervical cadaveric procedure, the DaVinci SP was installed for the transcervical approach and the DaVinci X surgical system for the abdominal transhiatal phase. Primary outcomes were operating time and lymphadenectomy.

Results The mobilization of the esophagus was successfully completed in 118 minutes by using the DaVinci SP for the transcervical phase and the DaVinci X for the transhiatal abdominal phase simultaneously. In total 18 lymph nodes were dissected in the thorax; 3 were located paratracheal right, 3 paratracheal left, 4 subcarinal, 4 para-aortic, 2 paraesophageal upper mediastinal, and 2 paraesophageal middle mediastinal.

Conclusion This preclinical study demonstrated that a fully robotic McKeown esophagectomy in simultaneous rendezvous technique using the DaVinci X for transhiatal dissection and the DaVinci SP for transcervical dissection was feasible with adequate lymphadenectomy in a cadaver model. Future research will elucidate the indications for the use of the fully robotic transhiatal and transcervical esophagectomy.

Keywords

minimally invasive surgery - esophageal surgery - robotic


Publication History

Received: 21 June 2020

Accepted: 13 July 2020

Article published online:
08 September 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 van der Sluis PC, Verhage RJ, van der Horst S, van der Wal WM, Ruurda JP, van Hillegersberg R. A new clinical scoring system to define pneumonia following esophagectomy for cancer. Dig Surg 2014; 31 (02) 108-116
    CrossrefPubMedSearch in Google Scholar
  • 2 Kutup A, Nentwich MF, Bollschweiler E, Bogoevski D, Izbicki JR, Hölscher AH. What should be the gold standard for the surgical component in the treatment of locally advanced esophageal cancer: transthoracic versus transhiatal esophagectomy. Ann Surg 2014; 260 (06) 1016-1022
    CrossrefPubMedSearch in Google Scholar
  • 3 Watanabe M, Yoshida N, Karashima R. et al. Transcervical superior mediastinal lymph node dissection combined with transhiatal lower esophageal dissection before transthoracic esophagectomy: a safe approach for salvage esophagectomy. J Am Coll Surg 2009; 208 (04) e7-e9
    CrossrefPubMedSearch in Google Scholar
  • 4 Egberts JH, Schlemminger M, Hauser C, Beckmann JH, Becker T. Robot-assisted cervical esophagectomy (RACE procedure) using a single port combined with a transhiatal approach in a rendezvous technique: a case series. Langenbecks Arch Surg 2019; 404 (03) 353-358
    CrossrefPubMedSearch in Google Scholar
  • 5 Grimminger PP, van der Sluis PC, Stein H, Lang H, van Hillegersberg R, Egberts JH. Feasibility of Transcervical robotic-assisted esophagectomy (TC-RAMIE) in a Cadaver study—a future outlook for an extrapleural approach. Appl Sci (Basel) 2019; 9: 3572
    CrossrefPubMedSearch in Google Scholar
  • 6 Mori K, Yoshimura S, Yamagata Y, Aikou S, Seto Y. Preclinical study of transcervical upper mediastinal dissection for esophageal malignancy by robot-assisted surgery. Int J Med Robot 2017; 13 (02) 13
    CrossrefPubMedSearch in Google Scholar
  • 7 Nakauchi M, Uyama I, Suda K. et al. Robot-assisted mediastinoscopic esophagectomy for esophageal cancer: the first clinical series. Esophagus 2019; 16 (01) 85-92
    CrossrefPubMedSearch in Google Scholar
  • 8 Valsangkar N, Salfity HVN, Timsina L, Ceppa DP, Ceppa EP, Birdas TJ. Operative time in esophagectomy: does it affect outcomes?. Surgery 2018; 164 (04) 866-871
    CrossrefPubMedSearch in Google Scholar
  • 9 Hulscher JB, van Sandick JW, de Boer AG. et al. Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the esophagus. N Engl J Med 2002; 347 (21) 1662-1669
    CrossrefPubMedSearch in Google Scholar
  • 10 Omloo JM, Lagarde SM, Hulscher JB. et al. Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the mid/distal esophagus: five-year survival of a randomized clinical trial. Ann Surg 2007; 246 (06) 992-1000 , discussion 1000–1001
    CrossrefPubMedSearch in Google Scholar
  • 11 Luketich JD, Alvelo-Rivera M, Buenaventura PO. et al. Minimally invasive esophagectomy: outcomes in 222 patients. Ann Surg 2003; 238 (04) 486-494 , discussion 494–495
    CrossrefPubMedSearch in Google Scholar
  • 12 Biere SS, van Berge Henegouwen MI, Maas KW. et al. Minimally invasive versus open oesophagectomy for patients with oesophageal cancer: a multicentre, open-label, randomised controlled trial. Lancet 2012; 379 (9829): 1887-1892
    CrossrefPubMedSearch in Google Scholar
  • 13 Mariette C, Markar SR, Dabakuyo-Yonli TS. et al; Fédération de Recherche en Chirurgie (FRENCH) and French Eso-Gastric Tumors (FREGAT) Working Group. Hybrid minimally invasive esophagectomy for esophageal cancer. N Engl J Med 2019; 380 (02) 152-162
    CrossrefPubMedSearch in Google Scholar
  • 14 van der Sluis PC, van der Horst S, May AM. et al. Robot-assisted minimally invasive thoracolaparoscopic esophagectomy versus open transthoracic esophagectomy for resectable esophageal cancer: a randomized controlled trial. Ann Surg 2019; 269 (04) 621-630
    CrossrefPubMedSearch in Google Scholar
  • 15 McCulloch P, Altman DG, Campbell WB. et al; Balliol Collaboration. No surgical innovation without evaluation: the IDEAL recommendations. Lancet 2009; 374 (9695): 1105-1112
    CrossrefPubMedSearch in Google Scholar