Robotically assisted Ivor-Lewis esophagectomy

Clinical History:

• A 79-year-old man diagnosed with a neoplasm of the distal third of the esophagus, stage uT2N1. He received neoadjuvant treatment with chemoradiation, with complete metabolic response in the restaging PET-CT scan.

  • Histology: moderately differentiated ADK.

  • Neoadjuvant treatment received: CROSS protocol (carboplatin/paclitaxel + 41.4Gy).

Other History:

• Arterial hypertension

• Parkinson's disease

• Atrial fibrillation anticoagulated with acenocoumarol

• Benign prostatic hyperplasia

Technique description:

• Robotically assisted Ivor-Lewis esophagectomy

Procedure steps:

This is a two-stage procedure: resection of both the distal part of the esophagus and the gastroesophageal junction + creation of a gastric conduit (abdominal part, performed via laparoscopy), ascension of the gastric conduit to the thorax and esophago-gastric hand-sewn anastomosis (thoracic part, robotically assisted).

1. Gastrolysis

2. Abdominal lymphadenectomy

3. Creation of the gastric tube/conduit

4. Ascension of structures to the thorax

1. Robotic docking.

2. Section of the azygos vein

3. Distal esophageal dissection + mediastinal lymphadenectomy 

4. Distal esophageal resection

5. Verification of correct vascularization with ICG green

6. Totally hand-sewn end-to-end esophago-gastric anastomosis 

Training Objectives:

• Key-steps of Ivor-Lewis esophagectomy

• Robotic surgery, tips and tricks