Robot-Assisted Thoracolaparoscopic Esophagectomy: The Netherlands

  • Roy J. J. Verhage
  • Christiaan Kroese
  • Richard van HillegersbergEmail author


For locally advanced esophageal cancer, radical surgical resection is the mainstay of treatment. Lymph node metastases occur along the entire tract of the esophagus in an early stage. Optimal treatment involves neo-adjuvant chemoradiotherapy followed by a two field thoraco-abdominal en bloc esophagectomy with an extensive mediastinal and truncal lymph node dissection.

Techniques for minimally invasive esophagectomy have been introduced to reduce surgical trauma and morbidity of traditional open esophagectomy. However, conventional endoscopic surgery is limited by 2-dimensional vision, reduced dexterity and limited degrees of freedom. Robotic systems were developed to overcome such limitations, enabling the surgeon to perform complex minimally invasive surgical procedures. Advantages include reduced blood loss and fast postoperative recovery.

This chapter describes the indications and preoperative considerations for robot-assisted thoracolaparoscopic esophagectomy. Furthermore, anesthesiological management is discussed, addressing important intraoperative issues such as single lung ventilation and fluid management.

The three-stage operative procedure is described in detail. The thoracoscopic phase is performed using the robotic DaVinci Si system (Intuitive Surgical Inc., Sunnyvale CA, USA). The laparoscopic phase is performed with conventional laparoscopy. A gastric conduit is created extracorporally and a cervical esophagogastric anastomosis is formed.

Additionally, the clinical care of patients after esophagectomy is discussed with a specific focus on anastomotic leakage and chylous leakage.


Esophagectomy Thoracoscopy Single lung ventilation Laparoscopy Gastric conduit Lymph node dissection Thoracic duct Anastomotic leakage Chylous leakage 


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Roy J. J. Verhage
    • 1
  • Christiaan Kroese
    • 2
  • Richard van Hillegersberg
    • 1
    Email author
  1. 1.Department of Surgical OncologyUniversity Medical Center UtrechtUtrechtThe Netherlands
  2. 2.Department of Anesthesiology, Intensive Care and Emergency SurgeryUniversity Medical Center UtrechtUtrechtThe Netherlands

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