Robot-assisted minimally invasive esophagectomy (RAMIE) with side-to-side semi-mechanical anastomosis: analysis of a learning curve.
Esophageal cancer
Learning curve
Minimally invasive surgery
Oncologic surgery
Robot-assisted minimally invasive thoraco-laparoscopic esophagectomy
Journal
Updates in surgery
ISSN: 2038-3312
Titre abrégé: Updates Surg
Pays: Italy
ID NLM: 101539818
Informations de publication
Date de publication:
Jun 2022
Jun 2022
Historique:
received:
04
01
2022
accepted:
20
03
2022
pubmed:
12
4
2022
medline:
24
6
2022
entrez:
11
4
2022
Statut:
ppublish
Résumé
Minimally invasive esophagectomy (MIE) reduces mortality and morbidity related to esophageal surgery, but a long learning curve is necessary due to the technical difficulties of thoracoscopy (35 to 119 patients required as reported in literature). Robot-assisted minimally invasive esophagectomy (RAMIE) with side-to-side semi-mechanical (SM) anastomosis may shorten completion of the learning curve. We present the results of the first 40 RAMIEs performed by a single surgeon with experience in esophageal and minimally invasive surgery. Patients included in this study underwent RAMIE between April 1, 2018 and April 30, 2021. According to the risk-adjusted cumulative sum analysis for postoperative complications, the first 19 patients were compared to the last 21. Pulmonary complications and atrial fibrillation occurred in 2.5% and 5% of cases, respectively. A single case of anastomotic leak in the early group was registered. Thirty-day mortality was 2.5%. R0 resection was obtained in all cases. No anastomotic strictures occurred during the follow-up (median of 20 months). A significant difference between the early group and the late one was observed for median operative time (425 vs 393 min, p = 0.001), estimated intraoperative blood loss (100 vs 50 ml, p = 0.003), Intensive Care Unit stay (days 2 vs 1, p = 0.004), hospital stay (days 13 vs 10, p = 0.007) and number of lymph nodes harvested (17 vs 21, p = 0.020). In conclusion, this study showed RAMIE to be safe and effective even in the early phase of its application. The learning curve resulted shorter than in MIE, with 19 patients needed to gain proficiency in our series.
Identifiants
pubmed: 35403978
doi: 10.1007/s13304-022-01284-8
pii: 10.1007/s13304-022-01284-8
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
907-916Informations de copyright
© 2022. Italian Society of Surgery (SIC).
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