Technical details for a robot-assisted hand-sewn esophago-gastric anastomosis during minimally invasive Ivor Lewis esophagectomy
| Autor: | Andrea Peri, Andrea Pietrabissa, N. Mineo, Luigi Pugliese, F. Bruno, J. Viganò, Luca Morelli, Niccolò Furbetta, F. S. Latteri, Virginia Gallo, G Di Franco |
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| Jazyk: | angličtina |
| Rok vydání: | 2021 |
| Předmět: |
Dynamic Manuscript
Leak medicine.medical_specialty Esophageal Neoplasms Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Esophageal cancer Robotic anastomosis Anastomotic Leak Anastomosis Minimally invasive surgery Esophagogastric anastomosis medicine Humans Ivor lewis Retrospective Studies Ivor Lewis esophagectomy SARS-CoV-2 business.industry Anastomosis Surgical COVID-19 Robotics medicine.disease Surgery Esophagectomy Barbed suture business Abdominal surgery |
| Zdroj: | Surgical Endoscopy |
| Popis: | Background Minimally invasive Ivor Lewis esophagectomy (MIILE) provides better outcomes than open techniques, particularly in terms of post-operative recovery and pulmonary complications. However, in addition to requiring advanced technical skills, thoracoscopic access makes it hard to perform esophagogastric anastomosis safely, and the reported rates of anastomotic leak vary from 5 to 16%. Several minimally invasive esophago-gastric anastomotic techniques have been described, but to date strong evidence to support one technique over the others is still lacking. We herein report the technical details and preliminary results of a new robot-assisted hand-sewn esophago-gastric anastomosis technique. Methods From January 2018 to December 2020, 12 cases of laparoscopic/thoracoscopic Ivor Lewis esophagectomy with robot-assisted hand-sewn esophago-gastric anastomosis were performed. The gastric conduit was prepared and tailored taking care of vascularization with a complete resection of the gastric fundus. The anastomosis consisted of a robot-assisted, hand-sewn four layers of absorbable monofilament running barbed suture (V-lock). The posterior outer layer incorporated the gastric and esophageal staple lines. Results The post-operative course was uneventful in nine cases. Two patients developed chyloperitoneum, one patient a Sars-Cov-2 infection, and one patient a late anastomotic stricture. In all cases, there were no anastomotic leaks or delayed gastric conduit emptying. The median post-operative stay was 13 days (min 7, max 37 days); the longest in-hospital stay was recorded in patients who developed chyloperitoneum. Conclusion Despite the small series, we believe that our technique looks to be promising, safe, and reproducible. Some key points may be useful to guarantee a low complications rate after MIILE, particularly regarding anastomotic leaks and delayed emptying: the resection of the gastric fundus, the use of robot assistance, the incorporation of the staple lines in the posterior aspect of the anastomosis, and the use of barbed suture. Further cases are needed to validate the preliminary, but very encouraging, results. Supplementary Information The online version contains supplementary material available at 10.1007/s00464-021-08715-4. |
| Databáze: | OpenAIRE |
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