101: Robotic Transhiatal Esophagectomy

Saturday, March 25, 2023

10:01 AM – 10:14 AM

Location: Veterans Memorial Auditorium

Video Presenter(s)

Moran Slavin, MD (she/her/hers)

Advanced Foregut and HPB Fellow
Digestive Health Institute Tampa
Tampa, Florida, United States

Disclosure(s): No financial relationships to disclose

First Author(s)

Moran Slavin, MD (she/her/hers)

Advanced Foregut and HPB Fellow
Digestive Health Institute Tampa
Tampa, Florida, United States

Disclosure(s): No financial relationships to disclose

Author(s)

SR

Sharona Ross, MD FSSO

Director Foregut and Pancreatic Surgery
Digestive Health Institute Tampa
Tampa, Florida, United States

Disclosure(s): Intuitive Surgical: Consultant (Ongoing), Speaker (Ongoing)
Iswanto Sucandy MD FACS, MD, FACS

Associate Professor of Surgery, University of Central Florida, College of Medicine Advanced Gastrointestinal Surgery | Hepatobiliary and Pancreatic Surgery
AdventHealth Tampa, Florida, United States

Disclosure(s): No financial relationships to disclose
AR

Alexander Rosemurgy, MD FACS FSSO

Attending HPB Surgeon
Digestive Health Institute Tampa, United States

Disclosure information not submitted.

Disclosure(s):

Moran Slavin, MD: No financial relationships to disclose

Sharona Ross, MD FSSO: Intuitive Surgical: Consultant (Ongoing), Speaker (Ongoing)

Iswanto Sucandy MD FACS, MD, FACS: No financial relationships to disclose

Introduction: This video depicts a robotic transhiatal esophagectomy and pyloromyotomy undertaken in a 71-year-old man with esophageal adenocarcinoma status post neoadjuvant chemoradiation.

Methods: The patient presented with dysphagia and unintentional weight loss. Preoperative EGD demonstrates an obstructive esophageal lesion and EUS/FNA confirmed esophageal adenocarcinoma. The patient underwent the CROSS protocol.

Results:

Dissection in the mediastinum was undertaken and circumstantially around the esophagus. A pyloromyotomy was undertaken to utilize a robotic hook-cautery and fenestrated bipolar forceps.
At the neck, an incision along the sternocleidomastoid muscle was made and the carotid artery and internal jugular vein were retracted laterally. The esophagogastrostomy anastomosis was completed with a laparoscopic endo-GIA-stapler and the defect was closed with uninterrupted silk sutures.
The patient tolerated the operation well and had an uneventful recovery. Pathology showed a complete response to neoadjuvant chemoradiation, and the patient was discharged on POD 7.

Conclusions:

Transhiatal esophagectomy can safely be undertaken robotically with minimal blood loss, reaping the benefits of minimally invasive surgery.

Learning Objectives:

Upon completion, participants will be able to identify major steps in a robotic transhiatal esophagectomy.
Upon completion, participants will be able to recognize the options of care for a patient with esophageal cancer who underwent neoadjuvant chemotherapy.
Upon completion, participants will be able to recognize the benefits of the minimally invasive approaches when utilized for complex oncological foregut operations.