Rozhl Chir. 2023;102(11):422-429. doi: 10.33699/PIS.2023.102.11.422-429.
Minimally invasive esophagectomy is associated with lower postoperative morbidity and better quality of life compared to open esophagectomy in patients with comparable oncological outcomes. Robotic-assisted surgery represents the next step in the development of mini- mally invasive surgery. We aim to present the results of a pilot cohort of patients undergoing robotic-assisted minimally invasive esophagectomy (RAMIE).
An initial cohort of patients with RAMIE was retrospectively analyzed. Operative characteristics, histopathological results, postoperative course, incidence of complications, and postoperative mortality were evaluated.
From 3/2022 to 6/2023, a total of 31 patients underwent RAMIE at our institution, including hybrid RAMIE (robotic abdomen, open chest) in 11 and total RAMIE in 20 patients. Most patients were male, had locally advanced tumors, predominantly adenocarcinoma and neoadjuvant treat- ment. Thirty patients had Ivor-Lewis and one patient had McKeown esophagectomy. The median total operative time was 495 minutes and median blood loss was 200 mL. R0 resection was achieved in 87% of patients. A median of 26 lymph nodes were removed. Postoperative Clavien-Dindo ≥3 complications occurred in 9 (29%) patients. Four (13%) patients required reoperation. Anastomotic leak was found in 5 (16%) and pneumonia in 9 (29%) patients. The median hospital stay was 9 days. One patient died in the postoperative period. Thirty-day and 90-day mortality rates were 0% and 3.2%, respectively.
Our initial experience shows that RAMIE is a safe surgical procedure and we consider its implementation at our institution to be success- ful. After overcoming the learning curve, we hope to reduce the operative time and increase the medical benefit for the patient.
与开放食管切除术相比，微创食管切除术在具有相似肿瘤学结果的患者中具有较低的术后发病率和更好的生活质量。机器人辅助手术代表了微创外科发展的下一步。我们旨在介绍接受机器人辅助微创食管切除术（RAMIE）的患者的试点队列的结果。
对 RAMIE 的初始患者队列进行回顾性分析。评估手术特点、组织病理学结果、术后过程、并发症发生率和术后死亡率。
从 2022 年 3 月至 2023 年 6 月，我院共对 31 例患者进行了 RAMIE，其中 11 例为杂交 RAMIE（机器人腹部，开胸），20 例为全 RAMIE。大多数患者为男性，患有局部晚期肿瘤，主要为腺癌和新辅助治疗。30 例患者行 Ivor-Lewis 手术，1 例患者行 McKeown 食管切除术。总手术时间中位数为 495 分钟，术中出血量中位数为 200 毫升。87%的患者达到了 R0 切除。中位数切除 26 枚淋巴结。9 例（29%）患者发生术后 Clavien-Dindo ≥3 级并发症。4 例（13%）患者需要再次手术。吻合口漏发生在 5 例（16%）患者中，肺炎发生在 9 例（29%）患者中。中位住院时间为 9 天。1 例患者术后死亡。30 天和 90 天死亡率分别为 0%和 3.2%。
我们的初步经验表明，RAMIE 是一种安全的手术方法，我们认为在我们机构实施是成功的。在克服学习曲线后，我们希望减少手术时间并为患者增加医疗效益。
