Robotic Esophagectomy, T4-Mid Esophagus

Robotic Esophagectomy, T4-Mid Esophagus

Vattikuti Fellow Aravindan R. produced this KS National Robotic Surgery Awards Runner-up for the 2019 Robotic Surgeons Council of India under the Mentorship of Dr. Somashekhar SP at Manipal Hospital.

Full title: ROBOTIC ESOPHAGECTOMY IN A CASE OF LOCALLY ADVANCED T4 CARCINOMA MID ESOPHAGUS

BACKGROUND AND AIMS: Locally advanced disease is a relative contra indication for minimally invasive surgeries. It needs more expertise to do radical resection safely in such complicated case. Here we present a case of T4 esophageal malignacy of mid esophagus operated with robotic radical two field esophagectomy.

Methods: A 60 year old male, presented  with locally advanced mid esophageal lesion, with CECT chest showing lesion in close relation with Left atrium, pulmonary vein and aorta. He underwent 4 cycles of neo adjuvant FLOT chemotherapy, which showed good response but still lesion was in close relation with vital structures. He was operated with DaVinci S  robotic system in prone position using 4 ports and 2 instruments. Esophagus was dissected off  the vital structures after incising the mediastinal pluera. Pulmonary vein , aorta, bronchus were able to be visualised and dissected under vision. Infra azygous dissection was followed by supra azygous part, preserving the recurrent laryngeal nerve. Complete R0 resection was achieved with mediastinal  lymphadenectomy.

Results: R0 radical resection is safely possible to do in locally advanced cases of carcinoma esophagus because of stable robotic arms and magnification, with out compromising the oncologic safety.

Robotic Surgery Video, narrated, with CT scans and photos, 07:46