Robot-assisted mediastinoscopic esophagectomy for esophageal cancer: the first clinical series
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Radical esophagectomy for esophageal cancer is associated with high morbidity, especially with pulmonary complications. Mediastinoscopic esophagectomy via a small left neck incision combined with the esophageal hiatus, without using transthoracic approach, has been reported to reduce pulmonary complication; however, from technical point of view, this approach using non-articulating, straight, long forceps is extremely challenging, especially in the middle mediastinal area. Its technical difficulties may be attenuated using da Vinci Surgical System. The aim of this study was to evaluate the feasibility and safety of robot-assisted mediastinoscopic esophagectomy.
Robot-assisted mediastinoscopic esophagectomy was performed in six patients between October 2016 and May 2017. Robotic esophageal mobilization with upper and middle mediastinal lymphadenectomy was performed via the three da Vinci Xi (Intuitive Surgical, Inc. Sunnyvale, CA) trocars placed on the 5-cm left cervical incision. Thereafter, the remaining part of radical esophagectomy was completed via a transhiatal approach.
Upper and middle mediastinal lymphadenectomy was robotically completed via the transcervical approach in all cases without conversion to transthoracic approach. No postoperative complications (Clavien–Dindo classification grade ≥ III) were observed.
Robot-assisted mediastinoscopic esophagectomy was technically feasible and safe. Use of da Vinci Surgical System may help attenuate technical difficulties in transcervical middle mediastinal lymph node dissection.
KeywordsEsophageal cancer Robotic Esophagectomy Mediastinoscopy
The authors are indebted to Maruzen CO., LTD. (Tokyo, Japan) for their native English speaker’s review of this manuscript. Intuitive Surgical, Inc. provided the necessary laboratory support in the preclinical cadaver study.
MN: assistant of surgeon, acquisition of data, drafting of manuscript. IU: operating surgeon, drafting and revision of manuscript. KS: drafting and revision of manuscript. SS: assistant of surgeon, drafting of manuscript. KK: assistant of surgeon, drafting of manuscript. SK: assistant of surgeon, drafting of manuscript. YI: drafting and revision of manuscript. KI: assistant of surgeon, drafting and revision of manuscript.
This work was not supported by any grants or funding. All authors have no commercial association or financial involvement that might pose a conflict of interest in connection with the submitted article.
Compliance with ethical standards
This study was approved by the institutional review board of Fujita Health University. All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions.
Conflict of interest
This work was not supported by any grants or funding. Masaya Nakauchi, Ichiro Uyama, Koichi Suda, Susumu Shibasaki, Kenji Kikuchi, Shinichi Kadoya, Yoshinori Ishida, and Kazuki Inaba have no conflicts of interest or financial ties to disclose.
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