Skip to main content

Advertisement

SpringerLink
Log in

Robot-assisted transcervical esophagectomy with a bilateral cervical approach for thoracic esophagectomy

  • Dynamic Manuscript
  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

Background

Thoracic esophageal cancer resection through the neck approach has recently been reported as mediastinoscopic surgery. We present the first report of a new minimally invasive technique for thoracic esophageal cancer: robot-assisted transcervical esophagectomy with a bilateral cervical approach.

Methods

Ten cases of robot-assisted bilateral transcervical esophagectomy performed at the National Cancer Center Hospital East, Japan, from February 2023 to August 2023 were reviewed. The short-term surgical outcomes were presented, and the feasibility and efficacy of this procedure were discussed.

Results

The mean operation time for the cervical procedure was 184.2 ± 23.6 min. The total time for the whole procedure was 472.7 ± 28.4 min, and total intraoperative blood loss was 162.2 ± 40.0 ml. Among the 10 cases, one patient developed recurrent nerve paralysis, one patient developed pulmonary complications, and no patients developed postoperative pneumonia. The median postoperative hospital stay was 22 (range: 12–43) days. No patients developed severe postoperative surgical complications, which were graded as Clavien–Dindo ≥ III. The total number of surgically harvested mediastinal lymph nodes was 37.2 ± 11.2.

Conclusions

Robot-assisted bilateral transcervical esophagectomy, a novel procedure for thoracic esophageal cancer, was safe and feasible. Using this procedure, the incidence of recurrent nerve palsy, which is a problem with transcervical esophagectomy and mediastinoscopic esophagectomy, is expected to decrease.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Müller-Stich BP, Probst P, Nienhüser H, Fazeli S, Senft J, Kalkum E, Heger P, Warschkow R, Nickel F, Billeter AT, Grimminger PP, Gutschow C, Dabakuyo-Yonli TS, Piessen G, Paireder M, Schoppmann SF, van der Peet DL, Cuesta MA, van der Sluis P, van Hillegersberg R, Hölscher AH, Diener MK, Schmidt T (2021) Meta-analysis of randomized controlled trials and individual patient data comparing minimally invasive with open oesophagectomy for cancer. Br J Surg 108:1026–1033

    Article  PubMed  Google Scholar 

  2. Mariette C, Markar SR, Dabakuyo-Yonli TS, Meunier B, Pezet D, Collet D, D’Journo XB, Brigand C, Perniceni T, Carrère N, Mabrut JY, Msika S, Peschaud F, Prudhomme M, Bonnetain F, Piessen G, Fédération de Recherche en Chirurgie (FRENCH) and French Eso-Gastric Tumors (FREGAT) Working Group (2019) Hybrid minimally invasive esophagectomy for esophageal cancer. N Engl J Med 380:152–162

    Article  PubMed  Google Scholar 

  3. Shanmugasundaram R, Hopkins R, Neeman T, Beenen E, Fergusson J, Gananadha S (2019) Minimally invasive McKeown’s vs open oesophagectomy for cancer: a meta-analysis. Eur J Surg Oncol 45:941–949

    Article  PubMed  Google Scholar 

  4. Tangoku A, Yoshino S, Abe T, Hayashi H, Satou T, Ueno T, Oka M (2004) Mediastinoscope-assisted transhiatal esophagectomy for esophageal cancer. Surg Endosc 18:383–389

    Article  CAS  PubMed  Google Scholar 

  5. Buess G, Becker HD (1990) Minimally invasive surgery in tumor of the esophagus. Langenbecks Arch Chir Supple II Verh Dtsch Chir. https://doi.org/10.1007/978-3-642-48163-5_287

    Article  Google Scholar 

  6. Daiko H, Oguma J, Fujiwara H, Ishiyama K, Kurita D, Sato T, Sato K, Faiz Z, Fujita T (2021) Novel universally applicable technique for performing bilateral transcervical mediastinoscopic-assisted transhiatal laparoscopic esophagectomy: a truly minimally invasive procedure. Surg Endosc 35:5186–5192

    Article  PubMed  Google Scholar 

  7. Dabsha A, Elkharbotly IAMH, Yaghmour M, Badr A, Badie F, Khairallah S, Esmail YM, Shmushkevich S, Hossny M, Rizk A, Ishak A, Wright J, Mohamed A, Rahouma M (2023) Novel mediastinoscope-assisted minimally invasive esophagectomy for esophageal cancer: a systematic review and meta-analysis. Ann Surg Oncol 30:4030–4039

    Article  PubMed  Google Scholar 

  8. Chen Z, Huang K, Wei R, Liu C, Fang Y, Wu B, Xu Z, Ding X, Tang H (2022) Transcervicalinflatable mediastinoscopic esophagectomy versus thoracoscopic esophagectomy for local early- and intermediate-stage esophageal squamous cell carcinoma: A propensity score-matched analysis. J Surg Oncol 125:839–846

    Article  PubMed  PubMed Central  Google Scholar 

  9. Jin Y, Lu X, Xue L, Zhao XJ (2019) Retrospective comparison of two minimally invasive esophagectomy in the treatment of esophageal cancer: pneumatic mediastinoscopy versus thoracoscopy. Laparoendosc Adv Surg Tech A 29:638–642

    Article  Google Scholar 

  10. Watanabe M, Kuriyama K, Terayama M, Okamura A, Kanamori J, Imamura Y (2023) Robotic-assisted esophagectomy: current situation and future perspectives. Ann Thorac Cardiovasc Surg. https://doi.org/10.5761/atcs.ra.23-00064

    Article  PubMed  PubMed Central  Google Scholar 

  11. Komatsu S, Konishi T, Matsubara D, Soga K, Shimomura K, Ikeda J, Taniguchi F, Fujiwara H, Shioaki Y, Otsuji E (2022) Continuous recurrent laryngeal nerve monitoring during single-port mediastinoscopic radical esophagectomy for esophageal cancer. J Gastrointest Surg 26:2444–2450

    Article  PubMed  Google Scholar 

  12. Chiu PW, de Groot EM, Yip HC, Egberts JH, Grimminger P, Seto Y, Uyama I, van der Sluis PC, Stein H, Sallum R, Ruurda JP, van Hillegersberg R (2020) Robot-assisted cervical esophagectomy: first clinical experiences and review of the literature. Dis Esophagus. https://doi.org/10.1093/dote/doaa052

    Article  PubMed  Google Scholar 

  13. Filz von Reiterdank ICLJ, Defize IL, de Groot EM, Wedel T, Grimminger PP, Egberts JH, Stein H, Ruurda JP, van Hillegersberg R, Bleys RLAW (2023) The surgical anatomy of a (robot-assisted) minimally invasive transcervical esophagectomy. Dis Esophagus. https://doi.org/10.1093/dote/doac072

    Article  PubMed  Google Scholar 

  14. Fujita T, Okada N, Horikiri Y, Sato T, Fujiwara H, Mayanagi S, Kanamori J, Yamamoto H, Daiko H (2019) Safety and efficacy of hydroxyethyl starch 6% 130/0.4/9 solution versus 5% human serum albumin in thoracic esophagectomy with 3-field lymph nodes dissection. Surg Today 49:427–434

    Article  CAS  PubMed  Google Scholar 

  15. Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, Santibaries E, Pekolj J, Slankamenac K, Bassi C, Graf R, Vonlanthen R, Padbury R, Cameron JL, Makuuchi M (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250:187–196

    Article  PubMed  Google Scholar 

  16. Davakis S, Charalabopoulos A, Kyros E, Sakarellos P, Tsourouflis G, Dimitroulis D, Nikiteas N (2022) Minimally Invasive transcervical esophagectomy with mediastinal lymphadenectomy for cancer. a comparison with standardized techniques. Anticancer Res 42:675–680

    Article  PubMed  Google Scholar 

  17. Chen X, Xue S, Xu J, Zhong M, Liu X, Lin G, Shen Y, Tan L (2020) Transcervical minimally invasive esophagectomy: hemodynamic study on an animal model. J Thorac Dis 12:6505–6513

    Article  PubMed  PubMed Central  Google Scholar 

  18. Wang Z, Yang R (2021) Radical minimally invasive esophagectomy for esophageal cancer via transcervical and transhiatal approaches: a narrative review. J Thorac Dis 13:5104–5110

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. van der Sluis P, Egberts JH, Stein H, Sallum R, van Hillegersberg R, Grimminger PP (2021) Transcervical (SP) and Transhiatal DaVinci robotic esophagectomy: a cadaveric study. Thorac Cardiovasc Surg 69:198–203

    Article  PubMed  Google Scholar 

  20. Tokairin Y, Nakajima Y, Kawada K, Hoshino A, Okada T, Ryotokuji T, Matsui T, Nagai K, Kawano T, Kinugasa Y (2019) The usefulness of a bilateral trans-cervical pneumomediastinal approach for mediastinoscopic radical esophagectomy: a right transcervical approach is an available option. Gen Thorac Cardiovasc Surg 67:884–890

    Article  PubMed  Google Scholar 

  21. Sasaki K, Tsuruda Y, Shimonosono M, Noda M, Uchikado Y, Arigami T, Matsushita D, Kita Y, Mori S, Kurahara H, Nakajo A, Ohtsuka T (2022) A comparison of the surgical invasiveness and short-term outcomes between thoracoscopic and pneumatic mediastinoscopic esophagectomy for esophageal cancer. Surg Today 52:1759–1765

    Article  CAS  PubMed  Google Scholar 

  22. Gong S, Rao X, Yuan Y, Yao X, Li G, Wang N, Li D, Jiang L (2023) Clinical-pathological features and perioperative outcomes of mediastinoscopy vs. thoracoscopy esophagectomy in esophageal cancer: a meta-analysis. Front Surg. https://doi.org/10.3389/fsurg.2023.1039615

    Article  PubMed  PubMed Central  Google Scholar 

  23. Ozawa S (2020) Minimally invasive surgery for esophageal cancer in Japan. Ann Thorac Cardiovasc Surg 26:179–183

    Article  PubMed  PubMed Central  Google Scholar 

  24. Tokairin Y, Nakajima Y, Kawada K, Hoshino A, Okada T, Ryotokuji T, Ogo T, Okuda M, Kume Y, Kawamura Y, Yamaguchi K, Nagai K, Kawano T, Kinugasa Y (2019) A feasibility study of mediastinoscopic radical esophagectomy for thoracic esophageal cancer from the viewpoint of the dissected mediastinal lymph nodes validated with thoracoscopic procedure: a prospective clinical trial. Esophagus 16:214–219

    Article  PubMed  Google Scholar 

  25. Chiu PWY, Ng SSM, Au SKW (2019) Transcervical minimally invasive esophagectomy using da Vinci® SP™ surgical system: a feasibility study in cadaveric model. Surg Endosc 33:1683–1686

    Article  PubMed  Google Scholar 

  26. Nakauchi M, Uyama I, Suda K, Shibasaki S, Kikuchi K, Kadoya S, Ishida Y, Inaba K (2019) Robot-assisted mediastinoscopic esophagectomy for esophageal cancer: the first clinical series. Esophagus 16:85–92

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We greatly appreciate the members of the Division of Esophageal Surgery for their critical discussion of our manuscript. We thank the members of the Division of Anesthesiology for reviewing and discussing the study, and Kelly Zammit, BVSc, and Jane Charbonneau, DVM, from Edanz Group (https://en-author-services.edanz.com/ac) for editing a draft of this manuscript.

Funding

This research did not receive any specific funding from any agencies in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Division of Esophageal Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan

    Takeo Fujita, Kazuma Sato, Naoto Fujiwara, Daisuke Kajiyama, Takashi Shigeno & Mayuko Otomo

  2. Division of Esophageal Surgery, National Cancer Center Hospital, Tokyo, Japan

    Hiroyuki Daiko

Authors
  1. Takeo Fujita
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kazuma Sato
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Naoto Fujiwara
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Daisuke Kajiyama
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Takashi Shigeno
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Mayuko Otomo
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Hiroyuki Daiko
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All persons who meet the authorship criteria are listed as authors. All authors certify that they have participated sufficiently in the work to take public responsibility for the content, including participation in the concept, design, analysis, writing, or revision of the manuscript.

Corresponding author

Correspondence to Takeo Fujita.

Ethics declarations

Disclosure

Takeo Fujita, Kazuma Sato, Naoto Fujiwara, Daisuke Kajiyama, Takashi Shigeno, Mayuko Otomo, and Hiroyuki Daiko have no conflicts of interest or financial ties to disclose.

Additional information

Publisher's Note

Springer nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (MP4 81358 KB) Video, Supplemental Digital Content 1. Video of right dorsal esophageal dissection with a right cervical approach.Video of right dorsal dissection of the esophagus while exposing the anterior surface of the vertebral body. The preserved thoracic duct can be seen in the left lateral direction.

Supplementary file2 (MP4 312245 KB) Video, Supplemental Digital Content 2. Representative scene in which the tracheoesophageal ligament is dissected with a left lateral approach. The tracheoesophageal attachment is dissected from the left side, and the tracheal bifurcation is approached while avoiding the left recurrent nerve ventrally. With a conventional mediastinoscope, there is often interference between the medial right-hand forceps and the left recurrent nerve; however, the multi-joint function of the robotic arm makes it possible to avoid this interference. The nerve integrated monitoring system also shows no decrease in the physiological and electrical activity of the left recurrent nerve.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Fujita, T., Sato, K., Fujiwara, N. et al. Robot-assisted transcervical esophagectomy with a bilateral cervical approach for thoracic esophagectomy. Surg Endosc 38, 1617–1625 (2024). https://doi.org/10.1007/s00464-024-10692-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-024-10692-3

Keywords

Search

Navigation