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Robot-assisted minimally invasive esophagectomy (RAMIE) with side-to-side semi-mechanical anastomosis: analysis of a learning curve

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Abstract

Minimally invasive esophagectomy (MIE) reduces mortality and morbidity related to esophageal surgery, but a long learning curve is necessary due to the technical difficulties of thoracoscopy (35 to 119 patients required as reported in literature). Robot-assisted minimally invasive esophagectomy (RAMIE) with side-to-side semi-mechanical (SM) anastomosis may shorten completion of the learning curve. We present the results of the first 40 RAMIEs performed by a single surgeon with experience in esophageal and minimally invasive surgery. Patients included in this study underwent RAMIE between April 1, 2018 and April 30, 2021. According to the risk-adjusted cumulative sum analysis for postoperative complications, the first 19 patients were compared to the last 21. Pulmonary complications and atrial fibrillation occurred in 2.5% and 5% of cases, respectively. A single case of anastomotic leak in the early group was registered. Thirty-day mortality was 2.5%. R0 resection was obtained in all cases. No anastomotic strictures occurred during the follow-up (median of 20 months). A significant difference between the early group and the late one was observed for median operative time (425 vs 393 min, p = 0.001), estimated intraoperative blood loss (100 vs 50 ml, p = 0.003), Intensive Care Unit stay (days 2 vs 1, p = 0.004), hospital stay (days 13 vs 10, p = 0.007) and number of lymph nodes harvested (17 vs 21, p = 0.020). In conclusion, this study showed RAMIE to be safe and effective even in the early phase of its application. The learning curve resulted shorter than in MIE, with 19 patients needed to gain proficiency in our series.

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Authors and Affiliations

  1. Department of Surgical Sciences, Molinette Hospital, University of Turin, C.so Bramante 88/90, 10126, Turin, Italy

    Fabrizio Rebecchi, Luca Domenico Bonomo, Antonio Salzano, Michele Camandona & Mario Morino

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  1. Fabrizio Rebecchi
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  2. Luca Domenico Bonomo
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  3. Antonio Salzano
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  4. Michele Camandona
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  5. Mario Morino
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Contributions

Data acquisition: LDB, FR, AS. Drafting of manuscript: LDB, FR, MM. Critical revision of manuscript: FR, MM, LDB, MC.

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Correspondence to Luca Domenico Bonomo.

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The authors declare they have no conflict of interest.

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The study is not a clinical trial. Ethical Committee approval and registration were not required.

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The study has been performed in accordance with the ethical standards of the Declaration of Helsinki and its later amendments.

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Rebecchi, F., Bonomo, L.D., Salzano, A. et al. Robot-assisted minimally invasive esophagectomy (RAMIE) with side-to-side semi-mechanical anastomosis: analysis of a learning curve. Updates Surg 74, 907–916 (2022). https://doi.org/10.1007/s13304-022-01284-8

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