Robotic-Assisted Minimally Invasive Esophagectomy (RAMIE): Ivor Lewis

Abstract

It has become increasingly recognized that minimally invasive esophagectomy (MIE) approaches have comparable oncologic and functional outcomes as open approaches. Additionally, a growing body of literature – including one prospective, randomized, controlled study – suggests that MIE provides improvements in pulmonary and wound complications and short-term pain indices, compared with open surgery.

Although the experience with robotic-assisted MIE (RAMIE) is relatively limited compared with standard MIE, experience with RAMIE is increasing. Published studies cite a wide range of surgical approaches featuring robotic assistance, most commonly with robotic assistance used for thoracoscopic esophageal mobilization. A smaller number of studies have described combined laparoscopic and thoracoscopic robotic esophagectomy with an anastomosis performed in either the neck or the chest. At our institution, we have developed and standardized one such RAMIE approach that uses a four-arm robotic platform for both the Ivor Lewis and McKeown (three-hole) approaches. The Ivor Lewis approach, which is most commonly performed in our service, is described here.