Background: Intrathoracic esophagogastrostomy plays an important role in minimally invasive Ivor-Lewis esophagectomy for cancer. Intrathoracic anastomosis with robot-assisted Ivor-Lewis esophagectomy (RAILE) includes hand-sewn and circular stapler methods, which remain technically challenging. In this study, we modified the techniques for intrathoracic anastomosis at RAILE, in order to simplify the complex procedures. Methods: “Side-insertion” technique was used for anvil placement and purse string suture for intrathoracic anastomosis at RAILE. Medical records for consecutive patients who had undergone robot-assisted minimally invasive Ivor-Lewis esophagectomy for cancer between January 2015 and June 2018 were analyzed. Results: A total of consecutive 31 patients were enrolled. There was no conversion to open thoracotomy in this cohort. Mean operation duration in the robotic group was 387.4 ± 68.2 min. Median estimated blood loss was 110 mL (range 50–400 mL). Two patients (6.5%) had postoperative anastomotic leak. No postoperative reoperation was needed and there were no mortality. Six patients (19.4%) had anastomotic stricture and 2 patients of them needed endoscopic dilation. Conclusion: RAILE is safe and feasible. Our modified procedure highlighting the “side-insertion” method may simplify the process of intrathoracic anvil placement and purse string suture for anastomosis at RAILE.

Cadiere GB, Dapri G, Himpens J, Fodderie L, Rajan A: Ivor Lewis esophagectomy with manual esogastric anastomosis by thoracoscopy in prone position and laparoscopy. Surg Endosc 2010; 24: 1482–1485.
Ben-David K, Sarosi GA, Cendan JC, Hochwald SN: Technique of minimally invasive Ivor Lewis esophagogastrectomy with intrathoracic stapled side-to-side anastomosis. J Gastroint Surg 2010; 14: 1613–1618.
Okabe H, Tanaka E, Tsunoda S, Obama K, Sakai Y: Intrathoracic esophagogastric anastomosis using a linear stapler following minimally invasive esophagectomy in the prone position. J Gastroint Surg 2013; 17: 397–402.
Nguyen TN, Hinojosa MW, Smith BR, Gray J, Reavis KM: Thoracoscopic construction of an intrathoracic esophagogastric anastomosis using a circular stapler: transoral placement of the anvil. Ann Thorac Surg 2008; 86: 989–992.
Jaroszewski DE, Williams DG, Fleischer DE, Ross HJ, Romero Y, Harold KL: An early experience using the technique of transoral OrVil EEA stapler for minimally invasive transthoracic esophagectomy. Ann Thorac Surg 2011; 92: 1862–1869.
Marangoni G, Villa F, Shamil E, Botha AJ: OrVilTM-assisted anastomosis in laparoscopic upper gastrointestinal surgery: friend of the laparoscopic surgeon. Surg Endosc 2012; 26: 811–817.
Kernstine KH, DeArmond DT, Karimi M, Van Natta TL, Campos JH, Yoder MR, Everett JE: The robotic, 2-stage, 3-field esophagolymphadenectomy. J Thorac Cardiovas Surg 2004; 127: 1847–1849.
Watson TJ: Robotic esophagectomy: is it an advance and what is the future? Ann Thorac Surg 2008; 85:S757–S759.
Ruurda JP, van der Sluis PC, van der Horst S, van Hilllegersberg R: Robot-assisted minimally invasive esophagectomy for esophageal cancer: a systematic review. J Surg Oncol 2015; 112: 257–265.
Park S, Hwang Y, Lee HJ, Park IK, Kim YT, Kang CH: Comparison of robot-assisted esophagectomy (RE) and thoracoscopic esophagectomy (TE) in esophageal squamous cell carcinoma. J Thorac Dis 2016; 8: 2853–2861.
Bongiolatti S, Annecchiarico M, Di Marino M, Boffi B, Borgianni S, Gonfiotti A, Voltolini L, Coratti A: Robot-sewn Ivor-Lewis anastomosis: preliminary experience and technical details. Int J Med Robot Surg 2016; 12: 421–426.
Trugeda S, Fernandez-Diaz MJ, Rodriguez-Sanjuan JC, Palazuelos CM, Fernandez-Escalante C, Gomez-Fleitas M: Initial results of robot-assisted Ivor-Lewis oesophagectomy with intrathoracic hand-sewn anastomosis in the prone position. Int J Med Robot Surg 2014; 10: 397–403.
de la Fuente SG, Weber J, Hoffe SE, Shridhar R, Karl R, Meredith KL: Initial experience from a large referral center with robotic-assisted Ivor Lewis esophagogastrectomy for oncologic purposes. Surg Endosc 2013; 27: 3339–3347.
Hodari A, Park KU, Lace B, Tsiouris A, Hammoud Z: Robot-assisted minimally invasive Ivor Lewis esophagectomy with real-time perfusion assessment. Ann Thorac Surg 2015; 100: 947–952.
Wee JO, Bravo-Iniguez CE, Jaklitsch MT: Early experience of robot-assisted esophagectomy with circular end-to-end stapled anastomosis. Ann Thorac Surg 2016; 102: 253–259.
Zhang H, Chen L, Geng Y, Zheng Y, Wang Y: Modified anastomotic technique for thoracolaparoscopic Ivor Lewis esophagectomy: early outcomes and technical details. Dis Esophagus 2017; 30: 1–5.
Wang WP, Gao Q, Wang KN, Shi H, Chen LQ: A prospective randomized controlled trial of semi-mechanical versus hand-sewn or circular stapled esophagogastrostomy for prevention of anastomotic stricture. World J Surg 2013; 37: 1043–1050.
Sarkaria IS, Rizk NP: Robotic-assisted minimally invasive esophagectomy: the Ivor Lewis approach. Thorac Surg Clin 2014; 24: 211–222, vii.
Puntambekar S, Kenawadekar R, Kumar S, Joshi S, Agarwal G, Reddy S, Mallik J: Robotic transthoracic esophagectomy. BMC Surg 2015; 15: 47.
Weksler B, Sharma P, Moudgill N, Chojnacki KA, Rosato EL: Robot-assisted minimally invasive esophagectomy is equivalent to thoracoscopic minimally invasive esophagectomy. Dis Esophagus 2012; 25: 403–409.
Fang W: [Interpretation of 2017 National Comprehensive Cancer Network (NCCN) guidelines for the diagnosis and treatment of esophageal squamous cell carcinoma through the new TNM staging of esophageal carcinoma (eighth edition) by the Union for International Cancer Control (UICC) and the American Cancer Commission (AJCC)]. Zhonghua Wei Chang Wai Ke Za Zhi 2017; 20: 1122–1126.
Giugliano DN, Berger AC, Rosato EL, Palazzo F: Total minimally invasive esophagectomy for esophageal cancer: approaches and outcomes. Langenbecks Arch Surg 2016; 401: 747–756.
van der Sluis PC, Ruurda JP, Verhage RJ, van der Horst S, Haverkamp L, Siersema PD, Borel Rinkes IH, Ten Kate FJ, van Hillegersberg R: Oncologic long-term results of robot-assisted minimally invasive thoraco-laparoscopic esophagectomy with two-field lymphadenectomy for esophageal cancer. Ann Surg Oncol 2015; 22(suppl 3):S1350–S1356.
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