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Optimization of robot-assisted thoracoscopic esophagectomy in the lateral decubitus position

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Abstract

Background

On the introduction of robot-assisted thoracoscopic esophagectomy (RATE), we refined the robotic system application to enhance our surgical experience obtained through thoracoscopic esophagectomy (TE) in the lateral decubitus position (LDP). Herein, we evaluate our methods introduced to optimize RATE in the LDP.

Methods

We performed RATE in the LDP with camera rotation and manual hand control assignment to reproduce the surgical view and manipulation of open esophagectomy. Forty patients underwent RATE between July 2018 and August 2020. After the initial 30 cases (initial RATE group), we optimized the port arrangement and robot settings in the most recent ten cases (recent RATE group). The surgical results of RATE were compared with those of 30 patients underwent TE between April 2014 and May 2019 selected by propensity score-matched analysis based on cStage (TE group).

Results

Operative duration was significantly longer in the initial RATE group than the TE group and the recent RATE group. Thoracic blood loss was significantly less in the initial RATE group than the TE group. Console time was significantly shorter in the recent RATE group than the initial RATE group. There was no surgical mortality in RATE and the surgical morbidity rate was similar in the three groups.

Conclusions

Camera rotation and manual hand control assignment during RATE in the LDP reproduced the surgical view and manipulation of open esophagectomy and TE in the LDP. The robotic platform enabled meticulous dissection and reduced blood loss, but was initially time-consuming. Optimization of the port arrangement minimized operative duration.

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Authors and Affiliations

  1. Department of Gastroenterological Surgery, Kanazawa University, 13-1 Takaramachi, Kanazawa, Ishikawa, 920-8641, Japan

    Itasu Ninomiya, Koichi Okamoto, Takahisa Yamaguchi, Hiroto Saito, Shiro Terai, Hideki Moriyama, Jun Kinoshita & Sachio Fushida

Authors
  1. Itasu Ninomiya
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  2. Koichi Okamoto
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  3. Takahisa Yamaguchi
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  4. Hiroto Saito
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  5. Shiro Terai
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  6. Hideki Moriyama
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  7. Jun Kinoshita
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  8. Sachio Fushida
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Corresponding author

Correspondence to Itasu Ninomiya.

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Ethical statement

All patients provided written informed consent before treatment, and the study was approved by the Ethics Committee of Kanazawa University Hospital. This work conforms to the guidelines set forth in the Helsinki Declaration of 1975 and later versions.

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10388_2021_813_MOESM1_ESM.tif

Supplementary file1. Transition of the duration of thoracic procedure and console time of robot assisted thoracoscopic esophagectomy (RATE) in the order of experience. Black column indicates the console time. Black with white column indicates the duration of the thoracic procedure. (TIF 377 KB)

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Ninomiya, I., Okamoto, K., Yamaguchi, T. et al. Optimization of robot-assisted thoracoscopic esophagectomy in the lateral decubitus position. Esophagus 18, 482–488 (2021). https://doi.org/10.1007/s10388-021-00813-5

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  • DOI: https://doi.org/10.1007/s10388-021-00813-5

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