“Robot-assisted thoracoscopic oesophagectomy for cancer.”
Boone, J., M. E. I. Schipper, et al. (2009).
British Journal of Surgery 96(8): 878-885.
Background: Thoracoscopic oesophagectomy was introduced to reduce the morbidity of transthoracic oesophagectomy. The aim was to assess the short- and mid-term results of robot-assisted thoracoscopic oesophagectomy for oesophageal cancer. Methods: Between October 2003 and May 2007, 47 patients with resectable oesophageal cancer underwent robot-assisted thoracoscopic oesophagectomy. Clinical data were collected prospectively. Results: Conversion to thoracotomy was necessary in seven patients. Median operating time was 450 min andmedian blood loss 625 ml.Median postoperative ventilation time was 1 day, intensive care stay 3 days and hospital stay 18 days. Twenty-one of 47 patients had pulmonary complications. Three patients died in hospital. A median of 29 (range 8-68) lymph nodes was dissected and R0 resection was achieved in 36 patients. Twenty-three patients had stage IVa disease. After a median follow-up of 35 months, median disease-free survival was 15 (95 per cent confidence interval 12 to 18) months. Conclusion: Robot-assisted thoracoscopic oesophagectomy was oncologically acceptable. Operating time, blood loss and pulmonary complications might decrease with further experience. Copyright © 2009 British Journal of Surgery Society Ltd. Published by John Wiley & Sons Ltd.
“Thoracoscopic esophagectomy for esophageal cancer: Feasibility and safety of robotic assistance in the prone position.”
Kim, D. J., W. J. Hyung, et al. (2009).
Journal of Thoracic and Cardiovascular Surgery.
Objective: To assess the feasibility and safety of robot-assisted thoracoscopic esophagectomy for esophageal cancer in the prone position. Methods: Twenty-one patients underwent robot-assisted thoracoscopic esophagectomy in the prone position by a surgical oncologist who had no prior experience with thoracoscopic esophagectomy. Hemodynamic and respiratory parameters were serially recorded to monitor changes in prone positioning. Results: All thoracoscopic procedures were completed with a robot-assisted technique followed by cervical esophagogastrostomy. R0 resection was achieved in 20 patients (95.2%), and the number of dissected nodes was 38.0 ± 14.2. Robot console time was significantly reduced from 176.3 ± 12.3 minutes in the initial 6 patients (group 1) to 81.7 ± 16.5 minutes in the latter 15 patients (group 2) (P = .000). In group 2, there was less blood loss (P = .018), more patients could be extubated in the operating room (P = .004), and the number of dissected mediastinal nodes tended to be increased (P = .093). There was no incidence of pneumonia or 90-day mortality. Major complications included anastomotic leakage in 4 patients, vocal cord palsy in 6 patients, and intra-abdominal bleeding in 1 patient. The prone position led to an elevation of central venous pressure and mean pulmonary arterial pressure and a decrease in static lung compliance. However, cardiac index and mean arterial pressure were well maintained with the acceptable range of partial pressure of arterial oxygen and carbon dioxide. Conclusion: Robotic assistance in the prone position is technically feasible and safe. Prone positioning was well tolerated, but preoperative risk assessment and meticulous anesthetic manipulation should be carried out. © 2009 The American Association for Thoracic Surgery.