Sharona Ross, MD, FACS, Janelle Spence, Iswanto Sucandy, MD, Alexander Rosemurgy, MD, FACS. Florida Hospital Tampa
Introduction: Esophageal cancer is an uncommon, yet lethal disease accounting for 1% of cancers diagnosed in the United States, and it is the seventh cause of cancer related death among men. As for any disease, it is important for surgeons to assess the benefits and drawbacks of different operative techniques, especially concerning upcoming, essential developments such as the robotic approach. This video documents a robotic transhiatal esophagectomy undertaken in a 65-year-old gentleman with a very large tumor in the distal esophagus.
Methods and Procedures: Technique of robotic transhiatal esophagectomy is described. A video is attached to this report.
Results: A 12mm port was placed at the umbilicus and two 8mm ports were placed to the right and left of the umbilicus at the mid-clavicular line. Two 5mm ports were placed cephalad to the umbilicus on the right and left auxiliary lines, respectively. Finally, a Gelport® was place in the right lower quadrant. The gastrohepatic omentum was opened and then the stomach and duodenum were mobilized. A wide Kocher maneuver was undertaken, and great care was taken to preserve the right gastroepiploic and right gastric arteries. Dissection was carried up into the mediastinum. A pyloromyotomy was undertaken. Vascular and purple-load Endo-GIA staplers were used to divide the left gastric artery at its origin and the proximal stomach. An incision was made on the border of the sternocleidomastoid muscle and dissection began with careful attention to adjacent nerves and vessels. The esophagus was mobilized in the neck and divided. The specimen was removed after being brought into the peritoneal cavity. The stomach was brought up into the neck and stapled esophagogastrostomy was constructed. Interrupted silk sutures were used to close the anastomosis. The stomach was sewn into the crura to avoid any torsion that would threaten the anastomosis. The trocar sites were closed absorbable sutures. A Jackson-Pratt drain was placed in the neck incision, which was closed with interrupted Vicryl sutures.
Conclusion: The robotic approach for transhiatal esophagectomy offers an alternative to conventional laparoscopy. The application of robotic transhiatal esophagectomy is highly encouraged and surgeons should implement this approach into their armamentarium.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 95967
Program Number: V273
Presentation Session: Video Loop Day 2
Presentation Type: VideoLoop