Initial Experience in Robot Assisted Minimally Invasive Esophagectomy (RAMIE)

Introduction: Minimally invasive esophageal surgery includes robot assisted approach. We here present our initial results of robot assisted minimally invasive esophagectomy in terms of quality of oncological resection, morbidity and mortality. Materials and methods: Data from our first 12 consecutive patients submitted to esophagectomy by RAMIE approach were prospectively collected between November 2015 and May 2016. Results: All our 12 patients were male patients with a median age of 64 years. Median BMI was 25 kg/m2 (20-29); ASA score classification was II (83%) and III (17%). Tumor type was adenocarcinoma in 66.7% and squamous cell carcinoma in 33.3% of patients. Tumor location was Siewert I in 16.7%, Siewert II in 8.3% and medium-distal esophagus in 75% of cases. 75% of patients received neoadjuvant treatment. Robot-assisted total esophagectomy was performed in 4 cases (33.3%) and robot-assisted Ivor-Lewis in 8 cases (66.7%). Conversion to thoracoscopy was necessary in one case due to pachypleuritis and there was no need to convert to open surgery. Median operating time was 320 min (210-480). Thoracic end-toend anastomosis was performed in 8 cases (66.7 %) and cervical anastomosis in 4 cases (33.3 %). There were 2 anastomotic leaks (17%). Resection was considered R0 in all cases. Median number of retrieved lymph nodes was 18 (6-35). Median ICU stay was 6.5 days (1-25). Median hospital stay was 13.9 days (8-28). 30-day mortality was 0%. Conclusion: Our first experience in RAMIE is acceptable, with adequate oncologic results and outcomes comparable to those of MIE. Keywords: Robotic Esophagectomy; RAMIE; Robotic Ivor-Lewis; Esophagus cancer