Robot-assisted hand-sewn intrathoracic anastomosis after esophagectomy

Background: In two-stage minimally invasive esophagectomy (MIE), most surgeons use a stapling device to avoid the challenges of thoracoscopic suturing in the upper mediastinum. However, in robot-assisted minimally invasive esophagectomy (RAMIE), the surgeon benefits from increased dexterity that facilitates the construction of a hand-sewn intrathoracic anastomosis. This study aimed to evaluate the outcomes of a refined technique for the robot-assisted hand-sewn intrathoracic anastomosis in RAMIE, which was introduced in 2016 in our center. Methods: Patients who underwent RAMIE with a robot-assisted hand-sewn intrathoracic anastomosis between 1 November 2019 and 1 November 2020 were included in the current retrospective study. During this time frame, the technique was uniform and no more refinements were made. Data were extracted from a prospectively maintained database. Main elements of the anastomotic technique included supportive stay-stitches to keep esophageal mucosa to the muscular wall, manual barbed suturing of the posterior and anterior wall, placement of tension releasing stitches and covering of the anastomosis with omentum. The primary outcome was anastomotic leakage and secondary outcomes included the duration of anastomosis construction. Results: During the inclusion period, 22 patients were included in the study. Anastomotic leakage occurred in 3 patients (14%), which involved a grade I leak in 2 patients (9%) and grade 3 leakage in 1 patient (5%). The total duration of anastomosis construction was 37 minutes (range, 25-48 minutes). Conclusions: This study shows that a robot-assisted hand-sewn intrathoracic anastomosis can yield good outcomes in RAMIE.