Laparoscopic, Robotic-Assisted Ivor Lewis Esophagectomy

Minia Hellan, MD, FACS; Jose R. Rodriguez, MD

Product Details
Product ID: ACS-5493
Year Produced: 2018
Length: 10 min.


This patient presents for robotic esophagectomy after chemoradiation for a T3N1 GE-junction adenocarcinoma. For the abdominal part the 4-arm daVinci XI robot is utilized. The robotic approach allows for steady retraction of the stomach with minimal manipulation of the conduit. The sealer is used to divide the gastrocolic ligament and short gastric vessels. The hook cautery is effective for the Kocher and lymphadenectomy along the left gastric artery. The esophagus is mobilized all the way into the right chest. The conduit is stapled with the robot undocked using 60 mm laparoscopic stapling loads. The conduit is not completely divided. The perfusion is evaluated with fluorescence imaging after injection of 2 ml IcG green. The thoracic part is performed in a left lateral decubitus position with 4 robotic arms and one assistant port. After mobilization of the esophagus, mediastinal lymphadenectomy and division of the azygos vein the proximal esophagus is divided with a black stapling load. We used the 25 mm Orvil EEA stapling system for the anastomosis. The anvil is pulled through the staple line and secured with a perstring. The robot is undocked, the assistant port enlarged, and the stomach exteriorized. The specimen is now fully divided. The EEA stapler is advanced into the conduit, internalized and under camera vision the esophagogastric anastomosis is stapled. The conduit tip is stapled off closing the gastric conduit. Patient was extubated in operating room. Esophagogram on POD 5 was negative for a leak and patient was discharged POD 6.