Surgical Endoscopy

, Volume 22, Issue 1, pp 188–195

Robotically assisted laparoscopic transhiatal esophagectomy

  • C. A. Galvani
  • M. V. Gorodner
  • F. Moser
  • G. Jacobsen
  • C. Chretien
  • N. J. Espat
  • P. Donahue
  • S. Horgan



Esophagectomy is a technically demanding operation with high procedure-related morbidity and mortality rates. Minimally invasive techniques were introduced in the late 1980s in an effort to decrease the invasiveness of the procedure. Data concerning the use of robotic systems for esophageal cancer are scarce in the literature. The goal of this report is to describe the authors’ early experience using robotically assisted technology to perform transhiatal esophagectomy (RATE).


Between September 2001 and May 2004, 18 patients underwent RATE at the authors’ institution. A retrospective review of prospectively collected data was performed. Gender, age, postoperative diagnosis, operative time, conversion rate, blood loss, hospital stay, length of the follow-up period, and complications were assessed.


At the authors’ institution, 18 patients underwent RATE, including 16 men (89%), with a mean age of 54 years (range, 41–73 years). The RATE procedure was completed for all 18 patients (100%). The mean operative time was 267 ± 71 min, and estimated blood loss was 54 ml (range, 10–150 ml). The mean intensive care unit stay was 1.8 days (range, 1–5 days), and the mean hospital stay was 10 days (range, 4–38 days). A total of 12 perioperative complications occurred for 9 patients, including 6 anastomotic leaks, 1 thoracic duct injury, 1 vocal cord paralysis, 1 pleural effusion, and 2 atrial fibrillations. Anastomotic stricture was observed in six patients. There were no perioperative deaths. Pathologic examination of the surgical specimen yielded an average of 14 lymph nodes per patient (range, 7–27). During the mean follow-up period of 22 ± 8 months, 2 patients died, 2 were lost to follow-up evaluation, 3 had recurrence, and 11 were disease free.


The current study shows that RATE, with its decreased blood loss, minimal cardiopulmonary complications, and no hospital mortality, represents a safe and effective alternative for the treatment of esophageal adenocarcinoma.


Complications Esophageal adenocarcinoma Esophageal resection Minimally invasive surgery Robotic surgery 


  1. 1.
    Bodner J, Wykypiel H, Wetscher G, Schmid T (2004) First experiences with the da Vinci operating robot in thoracic surgery. Eur J Cardiothorac Surg 25:844–851PubMedCrossRefGoogle Scholar
  2. 2.
    Cadiere GB, Himpens J, Germay O, Izizaw R, Degueldre M, Vandromme J, Capelluto E, Bruyns J (2001) Feasibility of robotic laparoscopic surgery: 146 cases. World J Surg 25:1467–1477PubMedGoogle Scholar
  3. 3.
    Chu KM, Law SY, Fok M, Wong JA (1997) Prospective randomized comparison of transhiatal and transthoracic resection for lower-third esophageal carcinoma. Am J Surg 174:320–324PubMedCrossRefGoogle Scholar
  4. 4.
    Cuschieri A, Shimi S, Banting S (1992) Endoscopic oesophagectomy through a right thoracoscopic approach. J R Coll Surg Edinb 37:7–11PubMedGoogle Scholar
  5. 5.
    De Paula AL, Hashiba K, Ferreira EA, de Paula RA, Grecco E (1995) Laparoscopic transhiatal esophagectomy with esophagogastroplasty. Surg Laparosc Endosc 5:1–5PubMedGoogle Scholar
  6. 6.
    Espat NJ, Jacobsen G, Horgan S, Donahue P (2005) Minimally invasive treatment of esophageal cancer: laparoscopic staging to robotic esophagectomy. Cancer J 11:10–17PubMedCrossRefGoogle Scholar
  7. 7.
    Gossot D, Cattan P, Fritsch S, Halimi B, Sarfati E, Celerier M (1995) Can the morbidity of esophagectomy be reduced by the thoracoscopic approach? Surg Endosc 9:1113–1115PubMedCrossRefGoogle Scholar
  8. 8.
    Horgan S, Knoblock L (2003) Esophageal surgery applications. In: Scott Melvin W, Nathaniel J. Soper (eds) Problems in general surgery. Robotics in general surgery, vol 20. Lippincott Williams & Wilkins, Inc., Philadelphia, pp 31–37Google Scholar
  9. 9.
    Horgan S, Berger RA, Elli EF, Espat NJ (2003) Robotic-assisted minimally invasive transhiatal esophagectomy. Am Surg 69:624–626PubMedGoogle Scholar
  10. 10.
    Jacobsen G, Elli F, Horgan S (2004) Robotic surgery update. Surg Endosc 18:1186–1191PubMedCrossRefGoogle Scholar
  11. 11.
    Kawahara K, Maekawa T, Okabayashi K, Hideshima T, Shiraishi T, Yoshinaga Y, Shirakusa T (1999) Video-assisted thoracoscopic esophagectomy for esophageal cancer. Surg Endosc 13:218–223PubMedCrossRefGoogle Scholar
  12. 12.
    Law S, Wong J (2002) Use of minimally invasive oesophagectomy for cancer of the oesophagus. Lancet Oncol 3:215–222PubMedCrossRefGoogle Scholar
  13. 13.
    Law S, Fok M, Chu KM, Wong J (1997) Thoracoscopic esophagectomy for esophageal cancer. Surgery 122:8–14PubMedCrossRefGoogle Scholar
  14. 14.
    Luketich JD, Schauer PR, Christie NA, Weigel TL, Raja S, Fernando HC, Keenan RJ, Nguyen NT (2000) Minimally invasive esophagectomy. Ann Thorac Surg 70:906–911, discussion 911–902PubMedCrossRefGoogle 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 238:486–494, discussion 494–485PubMedGoogle Scholar
  16. 16.
    McAnena OJ, Rogers J, Williams NS (1994) Right thoracoscopically assisted oesophagectomy for cancer. Br J Surg 81:236–238PubMedCrossRefGoogle Scholar
  17. 17.
    Moorthy K, Munz Y, Dosis A, Hernandez J, Martin S, Bello F, Rockall T, Darzi A (2004) Dexterity enhancement with robotic surgery. Surg Endosc 18(5):790–795PubMedCrossRefGoogle Scholar
  18. 18.
    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
  19. 19.
    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
  20. 20.
    Oelschlager BK, Pellegrini CA (2001) Role of laparoscopy and thoracoscopy in the treatment of esophageal adenocarcinoma. Dis Esophagus 14:91–94PubMedCrossRefGoogle Scholar
  21. 21.
    Okushiba S, Ohno K, Itoh K, Ohkashiwa H, Omi M, Satou K, Kawarada Y, Morikawa T, Kondo S, Katoh H (2003) Hand-assisted endoscopic esophagectomy for esophageal cancer. Surg Today 33:158–161PubMedCrossRefGoogle Scholar
  22. 22.
    Orringer MB, Marshall B, Iannettoni MD (1999) Transhiatal esophagectomy: clinical experience and refinements. Ann Surg 230:392–400, discussion 400–393PubMedCrossRefGoogle Scholar
  23. 23.
    Patti MG, Corvera CU, Glasgow RE, Way LW (1998) A hospital’s annual rate of esophagectomy influences the operative mortality rate. J Gastrointest Surg 2:186–192PubMedCrossRefGoogle Scholar
  24. 24.
    Peracchia A, Rosati R, Fumagalli U, Bona S, Chella B (1997) Thoracoscopic dissection of the esophagus for cancer. Int Surg 82:1–4PubMedGoogle Scholar
  25. 25.
    Swanstrom LL, Hansen P (1997) Laparoscopic total esophagectomy. Arch Surg 132:943–947, discussion 947–949PubMedGoogle Scholar
  26. 26.
    Urschel JD (1995) Esophagogastrostomy anastomotic leaks complicating esophagectomy: a review. Am J Surg 169:34–640CrossRefGoogle Scholar
  27. 27.
    Yamamoto S, Kawahara K, Maekawa T, Shiraishi T, Shirakusa T (2005) Minimally invasive esophagectomy for stage I and II esophageal cancer. Ann Thorac Surg 80:2070–2075PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • C. A. Galvani
    • 1
  • M. V. Gorodner
    • 1
  • F. Moser
    • 1
  • G. Jacobsen
    • 1
  • C. Chretien
    • 1
  • N. J. Espat
    • 1
  • P. Donahue
    • 1
  • S. Horgan
    • 1
  1. 1.Minimally Invasive Surgery CenterUniversity of IllinoisChicagoUSA

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