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Minimally Invasive Robotic Ivor Lewis Esophagectomy: ICG fluorescence gastric mobilization with 5mm scope and thoracic robotic assisted Esophagectomy with circular stapled anastomosis – modular step up approach for safe introduction of new technology

Hans F Fuchs, MD, Rolf Lambertz, MD, Wolfgang Schroeder, MD, Jessica Leers, MD, Christiane Bruns, MD. University of Cologne, Department of General Surgery

Introduction: The use of robotic technology in abdominal surgery in Europe is rapidly increasing. Aim of this study is to evaluate the introduction of new technologies in a center of excellence for upper gastrointestinal surgery.

Methods: A standardized teaching protocol of a complete OR team was performed in simulation and animal models at the center for the future of surgery (San Diego, CA) and IRCAD (Strasbourg, France) to receive certification as console surgeons. Starting 02/2017 the davinci xi and stryker ICG laparoscopy systems were introduced at our academic center (certified center of excellence for surgery of the upper gastrointestinal tract, n>250 esophageal cases/year). After simple training procedures based on our minimally invasive expertise were performed, difficulty was increased based on a modular step up approach to finally perform robotic thoracic assisted Ivor Lewis esophagectomy.

Results: From 02/2017 – 09/2017, a total of 30 cases were performed: cholecystectomy, n=8;  right colectomy, n=1; fundoplication, n=3, splenectomy, n=1; Heller myotomy n=4;  gastric mobilization, n=5; gastrectomy, n=1; pancreatic tail resection, n=1; thoracic esophagectomy, n=7). All cases were performed safely without operation-associated complications. Level of difficulty was increased based on our modular step up approach without quality compromises. Video documentation using the new technology is provided.

Fig.1 ICG gastric mobilization with Stryker 5mm scope

Fig.2 Radical thoracic robotic assisted esophagectomy (tracheal bifurcation)


 

Conclusion: The standardized training protocol and the University of Cologne modular step up approach allowed safe introduction of the new technology used. All cases were performed safely without operation-associated complications.


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 87773

Program Number: P814

Presentation Session: iPoster Session (Non CME)

Presentation Type: Poster

146

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