Robot-Assisted Minimally Invasive McKeown Esophagectomy with a Four-Arm Platform: Technique and Early Experience

Abstract

Objectives: We report an early, single-institution experience of Robot-Assisted Minimally
Invasive McKeown Esophagectomy (RAMIME) using a four-arm platform. The technique
details, rationale, complications, and pitfalls during procedure development are discussed.
Methods: This was a retrospective observational study.
Results: Nine of the 11 patients (median age: 57 years [range: 45-83]) had a complete (R0)
resection; 10 were given induction treatment combined with chemoradiation. The median
operative time was 795 min (range: 635-975). The median thoracoscopic console time was 270
min (range: 135-330). The median laparoscopic console time was 160 min (range: 150-260
min). The median blood loss was 300 cm3 (range: 100-650), and the median length of hospital
stay was 18 days (range: 14-36). The median number of lymph nodes harvested was 28 (range:
9-39). No patients were converted to open procedures. Four patients had major complications;
one died of liver failure on postoperative day 16; and none had clinically significant anastomotic
leaks.
Conclusions: RAMIME is feasible. With good understanding of the robotic concepts and a
good robotic team, RAMIME is worth trying. In addition to its well-known benefits, RAMIME
permits replacing one human assistant.