Minimally Invasive Esophagectomy May Be a Good Place To Transition To Robotics: An Analysis of the Data

Jeffrey R Watkins, MD, Houssam G Osman, MD, John L Jay, MD, Ernest L Dunn, MD, Rohan Jeyarajah, MD. Methodist Dallas Medical Center

Introduction: The aim of this study is to examine the transition from laparoscopic esophagectomy to robotic-assisted esophagectomy by comparing key metrics between two similar patient populations. Within the past decade the treatment for esophageal disease has progressed significantly from open thoracoscopic procedures to minimally invasive approaches. This study was conducted to examine if there was a steep learning curve in the transition from an experienced laparascopic esophagectomy technique to robotics.

Methods and Procedures: We identified 9 consecutive patients who underwent laparoscopic esophagectomy for benign and malignant disease over a one-year period immediately prior to the introduction of robotic surgery. We then compared these to 9 consecutive patients over a six-month period who underwent robotic-assisted trans-hiatal esophagectomy with cervical anastamosis. All procedures were performed by a single general and thoracic surgeon. Patient charts were reviewed and all relevant data were extracted and evaluated. Statistical analysis was performed.

Results: Total operative time was similar between the two groups at 254 minutes for laparoscopy and 260 minutes for robotic surgery (p = 0.57). Length of stay was similar at 10.0 days versus 9.4 days for laparoscopy and robotic respectively (p = 0.76). There was one questionable radiographic leak within the robot group that required no further intervention except repeat swallow study (p = 0.99). All procedures were performed for malignancy except for one patient in the laparoscopy group. Average body mass index (BMI) of 30 in the laparoscopic population did not differ significantly from BMI of 28 in robotic group (p = 0.52). Age in the two groups was similar as well (62 vs. 60, p = 0.57).

Conclusions: The transition from laparoscopic esophagectomy to robotic esophagectomy can be accomplished without significantly increasing operative time, length of stay or morbidity. Minimally invasive esophagectomy is a good place to transition to robotics with no demonstrable impact on quality metrics.