484. ROBOTIC ASSISTED PRONE ESOPHAGECTOMY USING VERSIUS PLATFORM: A PROMISING APPROACH

Background

Esophagectomy for cancer is a complex procedure with high morbidity. Minimally invasive approach offers the benefits of minimal access across the different fields required during this operation. Robotic surgery is becoming an integral part of modern practice. It holds the potential of more precision especially in narrow thoracic space. Currently, Many Robotic platforms exist. This video aims to demonstrate the feasibility of Robotic Mc Keown esophagectomy in the prone position using Versius platform.

Methods

56 years old male patient presented with grade I dysphagia of 3 months duration. His complete assessment revealed an 11 cm long invasive non keratinizing squamous cell carcinoma located in the mid esophagus (cT3N1M0). Marked regressive course of the lesion occurred with neoadjuvant chemoradiation. Robotic assisted Mc Keown esophagectomy was performed in the prone position. Thoracic phase was performed with the robotic approach. Bed side units and Port placement is illustrated in the video. The abdominal phase was accomplished laparoscopically. Finally, the stomach was pulled up and the esophagogastric anastomosis was done in the neck.

Results

No intraoperative adverse events were encountered. The improved vision, dexterity and articulation of instruments facilitated the identification of the thoracic duct, ligation of azygos vein tributaries and dissection of the recurrent laryngeal lymph nodes. Instrument clash was insignificant due to patient’s wide chest cavity and optimal positioning of ports and bed side units improving ergonomics. The operative time of the thoracic phase was 310 min. Blood loss was 300 mL. The postoperative course was uneventful except for chest infection which improved on conservative measures. The length of stay was 18 days. Pathology revealed complete clinical response with 0/25 lymph node yield.

Conclusion

Robotic assisted esophagectomy is feasible and can be safely performed using Versius robotic platform. The enhanced visualization and articulation enabled meticulous dissection of the recurrent laryngeal lymph nodes. Patient positioning, optimal port and bed side units placement were keys to achieving minimal instrument clash. Further research is needed to confirm these findings and to compare the long-term oncological outcomes and cost effectiveness of this modality.

Video links:

https://we.tl/t-rpkTHvNlXI

or

https://drive.google.com/drive/folders/1tOsFPrEBUHBpVn8C9jF7BGoNxlYPuBjq?usp=sharing.