Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
Langenbecks Arch Surg. 2024 Jun 19;409(1):190. doi: 10.1007/s00423-024-03378-w.
Robotic surgical systems with full articulation of instruments, tremor filtering, and motion scaling can potentially overcome the procedural difficulties in endoscopic surgeries. However, whether robot-assisted minimally invasive esophagectomy (RAMIE) can overcome anatomical difficulties during thoracoscopic esophagectomy remains unclear. This study aimed to clarify the anatomical and clinical factors that influence the difficulty of RAMIE in the thoracic region.
Forty-five patients who underwent curative-intent RAMIE with upper mediastinal lymph node dissection for esophageal cancer were included. Using preoperative computed tomography images, we calculated previously reported anatomical indices to assess the upper mediastinal narrowness and vertebral body projections in the middle thoracic region. The factors influencing thoracic operative time were then investigated.
During the thoracic procedure, the median operative time was 215 (124-367) min and the median blood loss was 20 (5-190) mL. Postoperatively, pneumonia, anastomotic leakage, and recurrent laryngeal nerve palsy occurred in 17.8%, 2.2%, and 6.7% of the patients, respectively. The multiple linear regression model revealed that a narrow upper mediastinum and greater blood loss during the thoracic procedure were significant factors associated with a prolonged thoracic operative time (P = 0.025 and P < 0.001, respectively). Upper mediastinal narrowing was not associated with postoperative complications.
A narrow upper mediastinum was significantly associated with a prolonged thoracic operative time in patients with RAMIE.
具有器械全关节运动、震颤过滤和运动缩放功能的机器人手术系统可能能够克服内窥镜手术中的操作困难。然而，机器人辅助微创食管切除术（RAMIE）是否能够克服胸腔镜食管切除术中的解剖困难尚不清楚。本研究旨在阐明影响 RAMIE 在胸部区域难度的解剖和临床因素。
纳入 45 例接受根治性 RAMIE 联合上纵隔淋巴结清扫术治疗食管癌的患者。使用术前计算机断层扫描图像，我们计算了先前报道的解剖指标，以评估中上纵隔的上纵隔狭窄和椎体投影。然后研究了影响胸腔手术时间的因素。
在胸腔手术过程中，中位手术时间为 215（124-367）分钟，中位出血量为 20（5-190）毫升。术后，17.8%的患者发生肺炎，2.2%的患者发生吻合口漏，6.7%的患者发生喉返神经麻痹。多元线性回归模型显示，狭窄的上纵隔和胸腔手术过程中更多的出血量是与胸腔手术时间延长相关的显著因素（P=0.025 和 P<0.001）。上纵隔狭窄与术后并发症无关。
在 RAMIE 患者中，狭窄的上纵隔与胸腔手术时间延长显著相关。
