Kitagami Hidehiko, Poudel Saseem, Kitayama Yosuke, Koinuma Junkichi, Ebihara Yuma, Hirano Satoshi
Robotic and Endoscopic Surgical Center, Keiyukai Sapporo Hospital, Hondori 9 Chome Minami 1-1, Shiroishi Ward, Sapporo, Hokkaido, Japan.
Department of Gastroenterological Surgery II, Faculty of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan.
J Robot Surg. 2025 Mar 10;19(1):107. doi: 10.1007/s11701-025-02269-6.
Robot-assisted minimally invasive esophagectomy (RAMIE) has shown potential benefits over conventional procedures for esophageal cancer. However, uniform surgical protocols are lacking, leading to variability in outcomes and increased costs. This retrospective study included 180 patients with esophageal cancer who underwent RAMIE between May 2018 and September 2024. A standardized approach, termed counterclockwise partitioned mediastinal dissection (CPMD), was introduced in 114 of these cases. Perioperative parameters including operative time, blood loss, complications, and cost of disposable instruments, were compared between patients treated before and after protocol standardization. Among the 114 patients who received the standardized RAMIE protocol, the median thoracic console time significantly decreased to 148 min, with overall blood loss reduced to 62 ml. No conversions to open surgery were required in either cohort. Compared to the pre-standardization group, postoperative complications-including recurrent laryngeal nerve paralysis-were lower and only one patient needed reoperation. Importantly, reusing robotic instruments from the thoracic phase in the abdominal phase reduced disposable instrument costs, resulting in a savings of approximately 168,000 Japanese Yen (USD 1050) per case. Implementing a standardized RAMIE protocol enhances procedural efficiency, reduces blood loss, and lowers costs without compromising surgical or oncological outcomes. This approach may facilitate broader adoption of RAMIE as a safe and cost-effective strategy for esophageal cancer surgery.
机器人辅助微创食管切除术（RAMIE）已显示出相较于传统食管癌手术的潜在优势。然而，目前缺乏统一的手术方案，导致手术结果存在差异且成本增加。这项回顾性研究纳入了2018年5月至2024年9月期间接受RAMIE手术的180例食管癌患者。其中114例采用了一种标准化方法，即逆时针分区纵隔清扫术（CPMD）。对标准化方案实施前后患者的围手术期参数进行比较，包括手术时间、失血量、并发症以及一次性器械成本。在接受标准化RAMIE方案的114例患者中，中位胸腔控制台操作时间显著降至148分钟，总失血量降至62毫升。两组均无需转为开放手术。与标准化前的组相比，术后并发症（包括喉返神经麻痹）减少，仅1例患者需要再次手术。重要的是，在腹部手术阶段重复使用胸腔阶段的机器人器械降低了一次性器械成本，每例节省约168,000日元（1050美元）。实施标准化的RAMIE方案可提高手术效率、减少失血量并降低成本，同时不影响手术或肿瘤学效果。这种方法可能有助于更广泛地采用RAMIE作为一种安全且具有成本效益的食管癌手术策略。
