Robot-assisted Ivor Lewis Esophagectomy (RAILE): A review of surgical techniques and clinical outcomes

The impact of surgical assistants on postoperative complications in robot-assisted Ivor-Lewis esophagectomy for esophageal carcinoma

Aim

This study examines the impact of different surgical assistants on robot-assisted Ivor Lewis esophagectomy. It aims to establish a foundation for refining surgical practices and improving patient outcomes.

Methods

The study included patients aged 18-75 with resectable esophageal squamous cell carcinoma, treated at Ruijin Hospital's Department of Thoracic Surgery (May 2015-November 2023). The robot-assisted Ivor Lewis esophagectomy (RAILE) was executed on a cohort of 97 patients, led by a highly experienced thoracic surgeon and assisted by three additional thoracic surgeons. Postoperative complications, including anastomotic leakage, pulmonary and cardiac events, as well as hemorrhages, were assessed using the Clavien-Dindo classification. The da Vinci Surgical System was used, and statistical analysis was performed using SPSS 20.0, with P = 0.05 as the significance threshold.

Results

Of the 97 patients, 50 were in Group A, 23 in Group B, and 24 in Group C. No major differences were found in anastomotic leakage, pneumonia, pneumothorax, severe cardiac complications, chylothorax, and vocal cord paralysis. Assistant C recorded a higher frequency of pleural effusion (45.8%) vs. Assistants A (16.0%) and B (21.7%). The duration of hospital stay was similar across groups, with median durations of 10 days for A, 8 days for B, and 10 days for C.

Conclusion

The study found no significant overall impact of different surgical assistants on postoperative complications in robot-assisted Ivor Lewis esophagectomy. However, pleural effusion rates varied, possibly due to surgical procedure and patient's condition and may be relevant to the assistant's procedure. Future research should involve larger, more varied samples to further validate and refine these findings.

Fashioning esophagogastric anastomosis in robotic Ivor-Lewis esophagectomy: a multicenter experience

BACKGROUND

The aim of the present study is to compare outcomes of the robotic hand-sewn, linear- and circular-stapled techniques performed to create an intrathoracic esophagogastric anastomosis in patients who underwent Ivor-Lewis esophagectomy.

METHODS

Patients who underwent a planned Ivor-Lewis esophagectomy were retrospectively analysed from prospectively maintained databases. Only patients who underwent a robotic thoracic approach with the creation of an intrathoracic esophagogastric anastomosis were included in the study. Patients were divided into three groups: hand-sewn-, circular stapled-, and linear-stapled anastomosis group. Demographic information and surgery-related data were extracted. The primary outcome was the rate of anastomotic leakages (AL) in the three groups. Moreover, the rate of grade A, B and C anastomotic leakage were evaluated. In addition, patients of each group were divided in subgroups according to the characteristics of anastomotic fashioning technique.

RESULTS

Two hundred and thirty patients were enrolled in the study. No significant differences were found between the three groups about AL rate (p = 0.137). Considering the management of the AL for each of the three groups, no significant differences were found. Evaluating the correlation between AL rate and the characteristics of anastomotic fashioning technique, no significant differences were found.

CONCLUSIONS

No standardized anastomotic fashioning technique has yet been generally accepted. This study could be considered a call to perform ad hoc high-quality studies involving high-volume centers for upper gastrointestinal surgery to evaluate what is the most advantageous anastomotic technique.