Single-Port da Vinci Robot-Assisted Cervical Esophagectomy: How to Do It.

IF 1.3 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Thoracic and Cardiovascular Surgeon Pub Date : 2024-09-29 DOI:10.1055/a-2405-2708
Edin Hadzijusufovic, Vladimir J Lozanovski, Eva-Verena Griemert, Luca Bellaio, Hauke Lang, Peter P Grimminger
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Abstract

Minimally invasive esophagectomies, including robot-assisted procedures, have demonstrated superiority over traditional open surgery. Despite the prevalence of transhiatal and transthoracic approaches, cervical access is less common in minimally invasive esophageal surgery. Advancements in robotic systems, such as the da Vinci Single Port (SP), enable controlled transcervical extrapleural mediastinoscopic access, potentially reducing pulmonary complications and extending surgical options to patients with comorbidities. The da Vinci SP robot-assisted cervical esophagectomy (SP-RACE) employs an SP and laparoscopic approach, demonstrating feasibility with comparable lymphadenectomy and recurrent nerve palsy rates to transthoracic methods. This technique, performed for the first time in Europe at the University Hospital Mainz, involves a transcervical SP phase that allows for effective mediastinal dissection and esophageal mobilization. Despite technical challenges due to limited space, robotic systems enhance controlled access and eliminate arm collision. The da Vinci SP platform's advantages include improved triangulation, fewer interferences, and better control of instruments in confined spaces. This novel approach shows promise for patients with high esophageal tumors and those unsuitable for transthoracic surgery, warranting further investigation into its clinical utility and reproducibility.

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单孔达文西机器人辅助颈椎食管切除术(SP-RACE)--如何操作。
微创食管切除术(包括机器人辅助手术)已证明优于传统的开放式手术。尽管经食道和经胸腔的方法很普遍,但颈部入路在微创食道手术中并不常见。机器人系统(如 daVinci Single-Port (SP))的进步使经颈部胸膜外纵隔镜入路成为可能,从而减少了肺部并发症,并为有合并症的患者提供了更多手术选择。daVinci SP机器人辅助颈食管切除术(SP-RACE)采用单孔腹腔镜方法,证明了其可行性,淋巴腺切除率和复发性神经麻痹率与经胸方法相当。美因茨大学医院在欧洲首次开展了这项技术,其中包括一个经颈部的SP阶段,可以有效地进行纵隔解剖和食管动员。尽管由于空间有限,机器人系统在技术上面临挑战,但它增强了可控性,消除了手臂碰撞。daVinci SP 平台的优势包括改善三角测量、减少干扰以及在狭窄空间内更好地控制器械。这种新方法有望用于食管肿瘤较高和不适合经胸手术的患者,值得进一步研究其临床实用性和可重复性。
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来源期刊
CiteScore
3.40
自引率
6.70%
发文量
365
审稿时长
3 months
期刊介绍: The Thoracic and Cardiovascular Surgeon publishes articles of the highest standard from internationally recognized thoracic and cardiovascular surgeons, cardiologists, anesthesiologists, physiologists, and pathologists. This journal is an essential resource for anyone working in this field. Original articles, short communications, reviews and important meeting announcements keep you abreast of key clinical advances, as well as providing the theoretical background of cardiovascular and thoracic surgery. Case reports are published in our Open Access companion journal The Thoracic and Cardiovascular Surgeon Reports.
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