Innovative fully robotic 4-arm Ivor Lewis esophagectomy for esophageal cancer (RAMIE4)

• Published in: Diseases of the esophagus Vol. 33; no. 3
• Main Authors: Grimminger, P P, Hadzijusufovic, E, Babic, B, van der Sluis, P C, Lang, H
• Format: Journal Article
• Language: English
• Published: United States Oxford University Press 16.03.2020
• Subjects: Abdominal Wall - surgery; Adenocarcinoma - pathology; Adenocarcinoma - surgery; Anastomosis, Surgical - instrumentation; Anastomosis, Surgical - methods; Esophageal Neoplasms - pathology; Esophageal Neoplasms - surgery; Esophagectomy - adverse effects; Esophagectomy - instrumentation; Esophagectomy - methods; Esophagus - diagnostic imaging; Esophagus - pathology; Esophagus - surgery; Feasibility Studies; Female; Germany; Humans; Male; Middle Aged; Neoplasm Staging; Outcome and Process Assessment, Health Care; Robotic Surgical Procedures - adverse effects; Robotic Surgical Procedures - instrumentation; Robotic Surgical Procedures - methods; Thoracoscopy - adverse effects; Thoracoscopy - instrumentation; Thoracoscopy - methods; Germany; RAMIE; esophageal cancer; circular stapler
• ISSN: 1120-8694; 1442-2050; 1442-2050
• DOI: 10.1093/dote/doz015

SUMMARY Nowadays robotic surgery is established for abdominal and thoracic surgery. It has been shown that complex procedures are feasible using robotic systems, e.g., da Vinci Xi, with a huge benefit in precision. Different techniques for esophageal cancer surgery are reported; however, only a few robotic and partial robotic procedures are described. Therefore, a fully robotic (abdominal and thoracic) Ivor Lewis esophageal resection using four robotic arms—RAMIE4—the standard technique used for lower esophageal cancer, is presented in this paper. The technique shown in the video was performed successfully in 100 cases in 24 months. The reconstruction is performed with a gastric conduit pull-up and intrathoracic manually inserted 28-mm circular end-to-side stapled anastomosis. This video demonstrates the feasibility of RAMIE4 in the abdomen and thorax and reveals advantages of the robotic assistance.