First results after introduction of RAMIE (Robot Assisted Minimal Invasive Esophagectomy) in a single institution
Oscar Åkesson, Dan FalkenbackAbstract
Introduction
RAMIE has been shown to be non-inferior to hybrid and open Esophagectomy. We have introduced robot assisted upper gastrointestinal surgery in a stepwise manner in our institution during a time period of three years. We report our first results after RAMIE.
Methods
Two surgeons from the upper GI-surgery team were taught robotic surgery through a structured teaching program including robotic simulator training, lab training and proctored live surgery. Independent robotic surgery was developed from hiatal hernia procedures to abdominal part Esophagectomy, Gastrectomy to thoracoabdominal Esophagectomy. RAMIE has been performed for approximately 14 months in our institution. The anastomosis is stapled, linear side-to-side with the robotic SureForm stapler, routinely proximal to the Azygos vein. ICG is used to assess the Gastric Tube. There was no patient selection for RAMIE. Access to robotic surgery was approximately three days in a month.
Results
Twentyseven patients have undergone RAMIE, two of which were McKeown procedures, all others Ivor Lewis esophagectomy. Mean operating time was 434 min, median length-of-stay was 9 postoperative days. Surgical complications, Clavien Dindo ≥3, occurred in 5 patients. In total, anastomotic leakage occurred in one patient, treated by EVAC. Chyle-leakage occurred in four cases, two treated with re-operation and two treated with drainage.
Discussion
Complex robotic surgery can be introduced maintaining good surgical results. Prerequisites are structured training, regular access to the robot and aiming at a high surgical volume for each robotic surgeon.