Surgical Endoscopy And Other Interventional Techniques

, Volume 20, Issue 9, pp 1435–1439 | Cite as

First experience with robot-assisted thoracoscopic esophagolymphadenectomy for esophageal cancer

  • R. van HillegersbergEmail author
  • J. Boone
  • W. A. Draaisma
  • I. A. M. J. Broeders
  • M. J. M. M. Giezeman
  • I. H. M. Borel Rinkes



Transthoracic esophagectomy with extended lymph node dissection is associated with higher morbidity rates than transhiatal esophagectomy. This morbidity rate could be reduced by the use of minimally invasive techniques. The feasibility of robot-assisted thoracoscopic esophagectomy (RTE) with mediastinal lymphadenectomy was assessed prospectively.


This study investigated 21 consecutive patients with esophageal cancer who underwent RTE using the Da Vinci™ robotic system. Continuity was restored with a gastric conduit and a cervical anastomosis.


A total of 18 (86%) procedures were completed thoracoscopically. The operating time for the thoracoscopic phase was 180 min (range, 120–240 min), and the median blood loss was 400 ml (range, 150–700 ml). A median of 20 (range, 9–30) lymph nodes were retrieved. The median intensive care unit stay was 4 days (range, 1–129 days), and the hospital stay was 18 days (range, 11–182 days). Pulmonary complications occurred in 10 patients (48%), and one patient (5%) died of a tracheoneoesophageal fistula.


In this initial experience, robot-assisted thoracoscopic esophagectomy was found to be feasible, providing an effective lymphadenectomy with low blood loss. Standardization of the technique and increased experience should reduce the complication rate, which is in the range of the rate for open transthoracic dissection.


Oesophageal cancer Lymphadenectomy Mediastinal lymphadenectomy Robot-assisted thoracoscopic esophagectomy Minimally invasive surgery 


  1. 1.
    Bessell JR, Maddern GJ, Manncke K, Ludbrook G, Jamieson GG (1994) Combined thoracoscopic and laparoscopic oesophagectomy and oesophagogastric reconstruction. Endosc Surg Allied Technol 2: 32–36PubMedGoogle Scholar
  2. 2.
    Broeders IA, Ruurda JP (2002) Robotics in laparoscopic surgery: current status and future perspectives. Scand J Gastroenterol 236: Suppl 76–80CrossRefGoogle Scholar
  3. 3.
    Buunen M, Gholghesaei M, Veldkamp R, Meijer DW, Bonjer HJ, Bouvy ND (2004) Stress response to laparoscopic surgery: a review. Surg Endosc 18: 1022–1028PubMedCrossRefGoogle Scholar
  4. 4.
    Cuesta MA, van den Broek WT, van der Peet DL, Meijer S (2004) Minimally invasive esophageal resection. Semin Laparosc Surg 11: 147–160PubMedGoogle Scholar
  5. 5.
    Cuschieri A, Shimi S, Banting S (1992) Endoscopic oesophagectomy through a right thoracoscopic approach. J R Coll Surg Edinb 37: 7–11PubMedGoogle Scholar
  6. 6.
    DePaula AL, Hashiba K, Ferreira EA, de Paula RA, Grecco E (1995) Laparoscopic transhiatal esophagectomy with esophagogastroplasty. Surg Laparosc Endosc 5: 1–5PubMedGoogle Scholar
  7. 7.
    Gossot D, Ghnassia MD, Debiolles H, Chourrout Y, Bonnichon JM, Sarfati E, Celerier M, Revillon Y (1992) Thoracoscopic dissection of the esophagus: an experimental study. Surg Endosc 6: 59–61PubMedCrossRefGoogle Scholar
  8. 8.
    Hubens G, Ruppert M, Balliu L, Vaneerdeweg W (2004) What have we learnt after two years working with the da Vinci robot system in digestive surgery? Acta Chir Belg 104: 609–614PubMedGoogle Scholar
  9. 9.
    Hulscher JB, Tijssen JG, Obertop H, van Lanschot JJ (2001) Transthoracic versus transhiatal resection for carcinoma of the esophagus: a meta-analysis. Ann Thorac Surg 72: 306–313PubMedCrossRefGoogle Scholar
  10. 10.
    Hulscher JB, van Sandick JW, de Boer AG, Wijnhoven BP, Tijssen JG, Fockens P, Stalmeier PF, ten Kate FJ, van Dekken H, Obertop H, Tilanus HW, van Lanschot JJ (2002) Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the esophagus. N Engl J Med 347: 1662–1669PubMedCrossRefGoogle Scholar
  11. 11.
    Hulscher JB, van Sandick JW, Tijssen JG, Obertop H, van Lanschot JJ (2000) The recurrence pattern of esophageal carcinoma after transhiatal resection. J Am Coll Surg 191: 143–148PubMedCrossRefGoogle Scholar
  12. 12.
    Kernstine KH, DeArmond DT, Karimi M, Van Natta TL, Campos JC, Yoder MR, Everett JE (2004) The robotic, 2-stage, 3-field esophagolymphadenectomy. J Thorac Cardiovasc Surg 127: 1847–1849PubMedCrossRefGoogle Scholar
  13. 13.
    Law S, Wong J (2002) Use of minimally invasive oesophagectomy for cancer of the oesophagus. Lancet Oncol 3: 215–222PubMedCrossRefGoogle Scholar
  14. 14.
    Lerut T, Coosemans W, Decker G, De Leyn P, Moons J, Nafteux P, Van Raemdonck D (2004) Extended surgery for cancer of the esophagus and gastroesophageal junction. J Surg Res 117: 58–63PubMedCrossRefGoogle Scholar
  15. 15.
    Luketich JD, Alvelo-Rivera M, Buenaventura PO, Christie NA, McCaughan JS, Litle VR, Schauer PR, Close JM, Fernando HC (2003) Minimally invasive esophagectomy: outcomes in 222 patients. Ann Surg 238: 486–494PubMedGoogle Scholar
  16. 16.
    Nguyen NT, Follette DM, Wolfe BM, Schneider PD, Roberts P, Goodnight JE, Jr (2000) Comparison of minimally invasive esophagectomy with transthoracic and transhiatal esophagectomy. Arch Surg 135: 920–925PubMedCrossRefGoogle Scholar
  17. 17.
    Nguyen NT, Roberts P, Follette DM, Rivers R, Wolfe BM (2003) Thoracoscopic and laparoscopic esophagectomy for benign and malignant disease: lessons learned from 46 consecutive procedures. J Am Coll Surg 197: 902–913PubMedCrossRefGoogle Scholar
  18. 18.
    Osugi H, Takemura M, Higashino M, Takada N, Lee S, Ueno M, Tanaka Y, Fukuhara K, Hashimoto Y, Fujiwara Y, Kinoshita H (2003) Learning curve of video-assisted thoracoscopic esophagectomy and extensive lymphadenectomy for squamous cell cancer of the thoracic esophagus and results. Surg Endosc 17: 515–519PubMedCrossRefGoogle Scholar
  19. 19.
    Swanstrom LL, Hansen P (1997) Laparoscopic total esophagectomy. Arch Surg 132: 943–947PubMedGoogle Scholar
  20. 20.
    Van den Broek WT, Makay O, Berends FJ, Yuan JZ, Houdijk AP, Meijer S, Cuesta MA (2004) Laparoscopically assisted transhiatal resection for malignancies of the distal esophagus. Surg Endosc 18: 812–817PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, Inc. 2006

Authors and Affiliations

  • R. van Hillegersberg
    • 1
    Email author
  • J. Boone
    • 1
  • W. A. Draaisma
    • 1
  • I. A. M. J. Broeders
    • 1
  • M. J. M. M. Giezeman
    • 2
  • I. H. M. Borel Rinkes
    • 1
  1. 1.Department of SurgeryUniversity Medical Center UtrechtUtrechtThe Netherlands
  2. 2.Department of AnaesthesiologyUniversity Medical Center UtrechtUtrechtThe Netherlands

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