Linear Stapled Technique for Robotic Assisted Minimally Invasive Esophagectomy

Background: Robotic assisted minimally invasive esophagectomy (RAMIE) is gaining increased popularity for the surgical treatment of esophageal cancer. Following resection of the specimen an anastomosis is formed between the gastric conduit, formed from the stomach, and the remaining esophagus. The method used for constructing this anastomosis varies widely between units-broadly speaking surgeons use a circular stapled, linear stapled or handsewn technique. Methods: Using a prospectively maintained database, we reviewed the first consecutive 30 RAMIE cases performed at our Centre. Outcomes, with particular focus on the anastomosis, were reviewed. We also describe in detail the technical steps involved in the formation of a fully robotic linear stapled, side -to -side, anastomosis. Results: We report on the first 30 patients undergoing RAMIE at our Centre, all of whom had a robotic linear stapled anastomosis. The patient characteristics were comparable to similar cancer cohorts reported on previously in terms of disease stage, age, sex and neoadjuvant treatment. Thirty- and 90 -day mortality was 0%. The technique appears to have a steep learning curve with a 50% leak rate in the first 10 cases, reducing to 15% in the subsequent 20 cases. Conclusions: Robotic linear stapled anastomosis following esophagectomy is safe and feasible. The apparent learning curve appears similar to handsewn and circular stapled techniques.