Robotic-assisted minimally invasive oesophagectomy for cancer: An initial experience

Chinnusamy Palanivelu; Sumanta Dey; Sandeep Sabnis; Raghavendra Gupta; Bharath Cumar; Saravana Kumar; Ramesh Natarajan; Parthasarathi Ramakrishnan

doi:10.4103/jmas.JMAS_7_18

Robotic-assisted minimally invasive oesophagectomy for cancer: An initial experience

J Minim Access Surg. 2019 Jul-Sep;15(3):234-241. doi: 10.4103/jmas.JMAS_7_18.

Authors

Chinnusamy Palanivelu¹, Sumanta Dey¹, Sandeep Sabnis¹, Raghavendra Gupta¹, Bharath Cumar¹, Saravana Kumar¹, Ramesh Natarajan¹, Parthasarathi Ramakrishnan¹

Affiliation

¹ Department of Gastrointestinal and Minimal Access Surgery, GEM Hospital and Research Centre, Coimbatore, Tamil Nadu, India.

Abstract

Background: The morbidity related to radical oesophagectomy can be reduced by adopting minimally invasive techniques. Over 250 thoraco-laparoscopic oesophagectomy (TLE) was done in our centre over the last 15 years, before adopting robotic surgery as the latest innovation in the field of minimally invasive surgery. Here, we share our initial experience of robotic-assisted minimally invasive oesophagectomy (RAMIE) for carcinoma oesophagus.

Methods: A prospective observational study conducted from February to December 2017. A total of 15 patients underwent RAMIE in this period. Data regarding demography, clinical characteristics, investigations, operating techniques, and post-operative outcome were collected in detail.

Results: There were 10 (66.7%) male patients and the median age of all patients was 62.9 (range 36-78) years. The median body mass index was 24.4 (range 15-32.8) kg/m². Twelve (80.0%) patients had squamous cell carcinoma (SCC) of the oesophagus and 3 (20%) patients had adenocarcinoma (AC). Five (33.3%) patients received neoadjuvant therapy. All 15 patients underwent RAMIE. Patients with SCC underwent McKeown's procedure, and those with AC underwent Ivor Lewis procedure. Extended two-field lymphadenectomy (including total mediastinal lymphadenectomy) was done for all the patients. The median operating time was 558 (range 390-690) min and median blood loss was 145 (range 90-230) ml. There were no intra-operative adverse events, and none of them required conversion to open or total thoracolaparoscopic procedure. The most common post-operative complications were recurrent laryngeal nerve paresis (3 patients, 20.0%) and pneumonia (2 patients, 13.3%). The median hospital stay was 9 (range 7-33) days. In total, 9 (60%) patients required adjuvant treatment.

Conclusion: Adequate experience in TLE can help minimally invasive surgeons in easy adoption of RAMIE with satisfactory outcome.

Keywords: Carcinoma oesophagus; Ivor-Lewis procedure; McKeown's procedure; robotic oesophagectomy; thoraco-laparoscopic oesophagectomy.