Robotic mediastinal dissection in the 3 field radical esophagectomy

Mario Masrur, MD, Antonio Gangemi, MD, Kristin Patton, MD, Despoina Daskalaki, MD, Pier Giulianotti, MD, FACS. University of Illinois at Chicago, Chicago, Illinois, USA..

The adoption of minimally invasive esophagectomy has increased worldwide since its first description more than 15 years ago. The technique has evolved from a transhiatal to a minimally invasive approach of the thorax that allows a safe and radical mediastinal dissection. We present a case of a stenotic lesion of the midesophagus suspicious of malignancy that was completely resected through a MIS approach.

Patients and Method
A 46 years old inmate male was referred for an obstructive lesion of the mid esophagus due to chronic perforation reaction. Preoperative CT scan showed a lesion with intraluminal vegetations in the midesophagus; an Upper GI Endoscopy was performed with biopsy sampling that failed to show malignancy. A failed endoscopic dilation rised the suspicious of malignancy. The decision was made to perform a robotic assisted thoracoscopic total esophagectomy with a radical dissection of the mediastinum with an extended lymphadenectomy and gastric conduit reconstruction.

In the OR, after oro-thracheal selective mono-bronchial intubation, a right robot-assisted thoracoscopic approach was achieved. The complete esophagus was dissected all around en-bloc with all Lymphatic tissue. Once thoracic part was completed an abdominal approach was perfomed to squeletonize the stomach and builds the gastric conduit. Finally through a cervicotomy, the reconstruction was performed in the neck. The main advantages of this procedure are the radicallity of the mediastinal en-bloc dissection preserving the benefits of the MIS approach.

In selected cases, a minimally invasive robotic approach may allow safe mediastinal en-bloc dissection and thorough thoracic lymph node dissection, respecting the oncological principles.


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