Modified exposure method for gastric mobilization in robot-assisted esophagectomy.

Background: We describe a modified method to facilitate gastric mobilization in robotic esophagectomy. Furthermore, we performed a prospective comparative analysis of surgical outcomes between the conventional method and described technique.

Methods: From April 1st, 2016 to December 31st, 2016, 59 consecutive patients were included who underwent robot-assisted McKeown esophagectomy for esophageal squamous cell carcinoma in our institution. They were subdivided into two groups based on the method of gastric exposure: a grasper retraction (GR) group (n=27) and a thread retraction (TR) group (n=32). For the GR patients, robotic instruments were directly used to expose the surgical field for gastric mobilization. However, for TR patients, the right gastroepiploic arcade and the short gastric vessels were fully exposed via a polyester tape combined with a thread loop.

Results: There was no incidence of postoperative 30-day mortality. The median gastric mobilization time was 53 min (range, 38-77 min). It took significantly less time in the TR group compared to the GR group (P=0.005). The median amount of blood loss was 8 mL (range, 5-14 mL), and no significant difference was found between the two groups (P=0.573). The median number of dissected lymph nodes was 10 (range, 7-16), and there was no significant difference between groups (P=0.386). Similarly, the postoperative morbidity rates did not statistically differ between the two groups (P=0.942).

Conclusions: The robot-assisted McKeown procedure presented is a safe and easy to perform technique for stomach retraction during gastric mobilization. Compared with the conventional GR method of gastric mobilization, TR requires less operating time and allows for an excellent operative field. The technique could, therefore, help surgeons to overcome some of the defects of robotic esophagectomy during gastric mobilization.