Implementation of robot-assisted Ivor Lewis procedure: Robotic hand-sewn, linear or circular technique? - 30/11/19

Doi : 10.1016/j.amjsurg.2019.11.031

Victor D. Plat ^a,^⁎ , Wessel T. Stam ^a, Linda J. Schoonmade ^b, David J. Heineman ^a,^c, Donald L. van der Peet ^a, Freek Daams ^a
^a Department of Gastrointestinal surgery, Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands
^b Medical Library, Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands
^c Department of Cardiothoracic surgery, Amsterdam UMC, VU University Medical Center, Amsterdam, the Netherlands

^∗Corresponding author. Department of Gastrointestinal Surgery, Amsterdam UMC, VU University Medical Center, De Boelelaan 1117, ZH 7F020, 1081, HV, Amsterdam, the Netherlands.Department of Gastrointestinal SurgeryVU University Medical CenterAmsterdam UMCDe Boelelaan 1117ZH 7F0201081AmsterdamHVthe Netherlands

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Saturday 30 November 2019

Abstract

Background

Robot-assisted surgery for esophageal cancer is increasingly applied. Despite this upsurge, the preferential technique to create a robot-assisted intrathoracic anastomosis has not been established.

Data sources

Bibliographic databases were searched to identify studies that performed a robot-assisted Ivor Lewis esophagectomy and described the technical details of the anastomotic technique. Out of 1701 articles, 16 studies were included for systematic review.

Conclusions

This review shows that all technique used to create a thoracoscopic anastomosis can be adopted to robotic surgery. Techniques can be divided into three categories: robotic hand-sewn, circular stapling or linear stapling and robotic hand-sewn closure of the stapler defect. With limited robotic experience, circular stapling might be the preferred technique, however requires a well-trained bedside assistant. The linear stapling technique or hand-sewn technique are more challenging but enable experienced robotic surgeons to perform a controlled anastomosis without bedside support.

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Highlights

•	All thoracoscopic anastomotic techniques can be adopted to robotic surgery.
•	Circular stapling is uniform, easy to learn and the best studied technique.
•	The linear stapled and hand-sewn anastomosis are less defined and more challenging.
•	Reliable data on outcomes of linear stapling and hand-sewn techniques is lacking.
•	During robotic implementation, surgeons could benefit from using circular stapling.