Research progress for robot-assisted esophagogastric anastomosis technique_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

PENG Hao ¹ , MAIERHABA Maitiasen ¹ , SHENG Siqi ² , SONG Haizhu ² , YI Jun ¹

1. Department of Cardiothoracic Surgery, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, P. R. China;
2. Department of Medical Oncology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, P. R. China;

Corresponding author：

Keywords：

Robotic anastomosis; esophageal cancer; gastroesophageal anastomosis; minimally invasive surgery; review

DOI：

10.7507/1007-4848.202303078

Video：

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Despite a wider application of robot to radical esophageal resection in recent years, the process of esophagogastrostomy is relatively complicated. Current commonly-applied clinical techniques in digestive tract reconstruction include end-to-end anastomosis, end-to-side anastomosis, and side-side anastomosis. The main methods are divided into manual and mechanical anastomosis. And the main instruments applied include circular stapler and linear stapler. Different technologies vary in advantages and restrictions and selecting the technique in esophageal operation depends on the situation of the tumor and the operator’s preference. The improved anastomosis techniques and the updated anastomosis instruments effectively lower the incidence of complications after esophagogastrostomy. However, there are still great difficulties in carrying out a safe and efficient reconstruction of the digestive tract during the operation. Scholars over the world have been working hard on it and have made modified various reconstruction techniques. Different technologies vary in advantages and restrictions and the choice of the technique depends on the situation of the tumor and the patient’s preference. There is no unified consensus on the choice of the technique. This paper introduces the research progress in robot’s assisted esophagogastrostomy from two aspects including the technique and method of anastomosis.

1.	Low DE, Kuppusamy MK, Alderson D, et al. Benchmarking complications associated with esophagectomy. Ann Surg, 2019, 269(2): 291-298.
2.	van Workum F, Slaman AE, van Berge Henegouwen MI, et al. Propensity score-matched analysis comparing minimally invasive Ivor Lewis versus minimally invasive Mckeown esophagectomy. Ann Surg, 2020, 271(1): 128-133.
3.	Verstegen MHP, Slaman AE, Klarenbeek BR, et al. Outcomes of patients with anastomotic leakage after transhiatal, McKeown or Ivor Lewis esophagectomy: A nationwide cohort study. World J Surg, 2021, 45(11): 3341-3349.
4.	van Workum F, Verstegen MHP, Klarenbeek BR, et al. Intrathoracic vs cervical anastomosis after totally or hybrid minimally invasive esophagectomy for esophageal cancer: A randomized clinical trial. JAMA Surg, 2021, 156(7): 601-610.
5.	Zhang H, Wang Z, Zheng Y, et al. Robotic side-to-side and end-to-side stapled esophagogastric anastomosis of Ivor Lewis esophagectomy for cancer. World J Surg, 2019, 43(12): 3074-3082.
6.	van der Sluis PC, Tagkalos E, Hadzijusufovic E, et al. Robot-assisted minimally invasive esophagectomy with intrathoracic anastomosis (Ivor Lewis): Promising results in 100 consecutive patients (the European experience). J Gastrointest Surg, 2021, 25(1): 1-8.
7.	Valverde A, Hay JM, Fingerhut A, et al. Manual versus mechanical esophagogastric anastomosis after resection for carcinoma: A controlled trial. French Associations for Surgical Research. Surgery, 1996, 120(3): 476-483.
8.	Cooke DT, Lin GC, Lau CL, et al. Analysis of cervical esophagogastric anastomotic leaks after transhiatal esophagectomy: Risk factors, presentation, and detection. Ann Thorac Surg, 2009, 88(1): 177-184.
9.	Kondra J, Ong SR, Clifton J, et al. A change in clinical practice: A partially stapled cervical esophagogastric anastomosis reduces morbidity and improves functional outcome after esophagectomy for cancer. Dis Esophagus, 2008, 21(5): 422-429.
10.	So KO, Park JM. Totally laparoscopic total gastrectomy using intracorporeally hand-sewn esophagojejunostomy. J Gastric Cancer, 2011, 11(4): 206-211.
11.	Xie MR, Liu CQ, Guo MF, et al. Short-term outcomes of minimally invasive Ivor-Lewis esophagectomy for esophageal cancer. Ann Thorac Surg, 2014, 97(5): 1721-1727.
12.	Misawa K, Hachisuka T, Kuno Y, et al. New procedure for purse-string suture in thoracoscopic esophagectomy with intrathoracic anastomosis. Surg Endosc, 2005, 19(1): 40-42.
13.	Usui S, Ito K, Hiranuma S, et al. Hand-assisted laparoscopic esophagojejunostomy using newly developed purse-string suture instrument "Endo-PSI". Surg Laparosc Endosc Percutan Tech, 2007, 17(2): 107-110.
14.	Usui S, Nagai K, Hiranuma S, et al. Laparoscopy-assisted esophagoenteral anastomosis using endoscopic purse-string suture instrument "Endo-PSI (Ⅱ)" and circular stapler. Gastric Cancer, 2008, 11(4): 233-237.
15.	Chen D, Cheng P, Ding D, Ke Z. Feasibility and safety of a novel reverse puncture device (RPD) for laparoscopic esophagogastrostomy/esophagojejunostomy. Int J Clin Exp Med, 2014, 7(9): 2497-2503.
16.	Omori T, Oyama T, Mizutani S, et al. A simple and safe technique for esophagojejunostomy using the hemidouble stapling technique in laparoscopy-assisted total gastrectomy. Am J Surg, 2009, 197(1): e13-e17.
17.	Chong-Wei K, Dan-Lei C, Dan D. A modified technique for esophagojejunostomy or esophagogastrostomy after laparoscopic gastrectomy. Surg Laparosc Endosc Percutan Tech, 2013, 23(3): e109-e115.
18.	Peng H, Liu YY, Aimudula M, et al. A safe and effective anastomotic technique for robot-assisted minimally invasive oesophagectomy: Reverse-puncture anastomosis. Int J Med Robot, 2022, 18(1): e2336.
19.	LaFemina J, Viñuela EF, Schattner MA, et al. Esophagojejunal reconstruction after total gastrectomy for gastric cancer using a transorally inserted anvil delivery system. Ann Surg Oncol, 2013, 20(9): 2975-2983.
20.	Steichen FM. The use of staplers in anatomical side-to-side and functional end-to-end enteroanastomoses. Surgery, 1968, 64(5): 948-953.
21.	Inaba K, Satoh S, Ishida Y, et al. Overlap method: novel intracorporeal esophagojejunostomy after laparoscopic total gastrectomy. J Am Coll Surg, 2010, 211(6): e25-e29.
22.	Zhou D, Liu QX, Deng XF, et al. Comparison of two different mechanical esophagogastric anastomosis in esophageal cancer patients: A meta-analysis. J Cardiothorac Surg, 2015, 10: 67.
23.	Cerfolio RJ, Bryant AS, Hawn MT. Technical aspects and early results of robotic esophagectomy with chest anastomosis. J Thorac Cardiovasc Surg, 2013, 145(1): 90-96.
24.	Bongiolatti S, Annecchiarico M, Di Marino M, et al. Robot-sewn Ivor-Lewis anastomosis: Preliminary experience and technical details. Int J Med Robot, 2016, 12(3): 421-426.
25.	Kim RH, Takabe K. Methods of esophagogastric anastomoses following esophagectomy for cancer: A systematic review. J Surg Oncol, 2010, 101(6): 527-533.
26.	Marano A, Salomone S, Pellegrino L, et al. Robot-assisted esophagectomy with robot-sewn intrathoracic anastomosis (Ivor Lewis): Surgical technique and early results. Updates Surg, 2023, 75(4): 941-952.
27.	Markar SR, Karthikesalingam A, Vyas S, et al. Hand-sewn versus stapled oesophago-gastric anastomosis: Systematic review and meta-analysis. J Gastrointest Surg, 2011, 15(5): 876-884.
28.	Ben-David K, Sarosi GA, Cendan JC, et al. Technique of minimally invasive Ivor Lewis esophagogastrectomy with intrathoracic stapled side-to-side anastomosis. J Gastrointest Surg, 2010, 14(10): 1613-1618.
29.	Schröder W, Raptis DA, Schmidt HM, et al. Anastomotic techniques and associated morbidity in total minimally invasive transthoracic esophagectomy: Results From the EsoBenchmark database. Ann Surg, 2019, 270(5): 820-826.
30.	van Heijl M, Gooszen JA, Fockens P, et al. Risk factors for development of benign cervical strictures after esophagectomy. Ann Surg, 2010, 251(6): 1064-1069.
31.	Wang S, Lin S, Wang H, et al. Reconstruction methods after radical proximal gastrectomy: A systematic review. Medicine (Baltimore), 2018, 97(11): e0121.
32.	Wang H, Hao Q, Wang M, et al. Esophagojejunostomy after laparoscopic total gastrectomy by OrVil™ or hemi-double stapling technique. World J Gastroenterol, 2015, 21(29): 8943-8951.

1. Low DE, Kuppusamy MK, Alderson D, et al. Benchmarking complications associated with esophagectomy. Ann Surg, 2019, 269(2): 291-298.
2. van Workum F, Slaman AE, van Berge Henegouwen MI, et al. Propensity score-matched analysis comparing minimally invasive Ivor Lewis versus minimally invasive Mckeown esophagectomy. Ann Surg, 2020, 271(1): 128-133.
3. Verstegen MHP, Slaman AE, Klarenbeek BR, et al. Outcomes of patients with anastomotic leakage after transhiatal, McKeown or Ivor Lewis esophagectomy: A nationwide cohort study. World J Surg, 2021, 45(11): 3341-3349.
4. van Workum F, Verstegen MHP, Klarenbeek BR, et al. Intrathoracic vs cervical anastomosis after totally or hybrid minimally invasive esophagectomy for esophageal cancer: A randomized clinical trial. JAMA Surg, 2021, 156(7): 601-610.
5. Zhang H, Wang Z, Zheng Y, et al. Robotic side-to-side and end-to-side stapled esophagogastric anastomosis of Ivor Lewis esophagectomy for cancer. World J Surg, 2019, 43(12): 3074-3082.
6. van der Sluis PC, Tagkalos E, Hadzijusufovic E, et al. Robot-assisted minimally invasive esophagectomy with intrathoracic anastomosis (Ivor Lewis): Promising results in 100 consecutive patients (the European experience). J Gastrointest Surg, 2021, 25(1): 1-8.
7. Valverde A, Hay JM, Fingerhut A, et al. Manual versus mechanical esophagogastric anastomosis after resection for carcinoma: A controlled trial. French Associations for Surgical Research. Surgery, 1996, 120(3): 476-483.
8. Cooke DT, Lin GC, Lau CL, et al. Analysis of cervical esophagogastric anastomotic leaks after transhiatal esophagectomy: Risk factors, presentation, and detection. Ann Thorac Surg, 2009, 88(1): 177-184.
9. Kondra J, Ong SR, Clifton J, et al. A change in clinical practice: A partially stapled cervical esophagogastric anastomosis reduces morbidity and improves functional outcome after esophagectomy for cancer. Dis Esophagus, 2008, 21(5): 422-429.
10. So KO, Park JM. Totally laparoscopic total gastrectomy using intracorporeally hand-sewn esophagojejunostomy. J Gastric Cancer, 2011, 11(4): 206-211.
11. Xie MR, Liu CQ, Guo MF, et al. Short-term outcomes of minimally invasive Ivor-Lewis esophagectomy for esophageal cancer. Ann Thorac Surg, 2014, 97(5): 1721-1727.
12. Misawa K, Hachisuka T, Kuno Y, et al. New procedure for purse-string suture in thoracoscopic esophagectomy with intrathoracic anastomosis. Surg Endosc, 2005, 19(1): 40-42.
13. Usui S, Ito K, Hiranuma S, et al. Hand-assisted laparoscopic esophagojejunostomy using newly developed purse-string suture instrument "Endo-PSI". Surg Laparosc Endosc Percutan Tech, 2007, 17(2): 107-110.
14. Usui S, Nagai K, Hiranuma S, et al. Laparoscopy-assisted esophagoenteral anastomosis using endoscopic purse-string suture instrument "Endo-PSI (Ⅱ)" and circular stapler. Gastric Cancer, 2008, 11(4): 233-237.
15. Chen D, Cheng P, Ding D, Ke Z. Feasibility and safety of a novel reverse puncture device (RPD) for laparoscopic esophagogastrostomy/esophagojejunostomy. Int J Clin Exp Med, 2014, 7(9): 2497-2503.
16. Omori T, Oyama T, Mizutani S, et al. A simple and safe technique for esophagojejunostomy using the hemidouble stapling technique in laparoscopy-assisted total gastrectomy. Am J Surg, 2009, 197(1): e13-e17.
17. Chong-Wei K, Dan-Lei C, Dan D. A modified technique for esophagojejunostomy or esophagogastrostomy after laparoscopic gastrectomy. Surg Laparosc Endosc Percutan Tech, 2013, 23(3): e109-e115.
18. Peng H, Liu YY, Aimudula M, et al. A safe and effective anastomotic technique for robot-assisted minimally invasive oesophagectomy: Reverse-puncture anastomosis. Int J Med Robot, 2022, 18(1): e2336.
19. LaFemina J, Viñuela EF, Schattner MA, et al. Esophagojejunal reconstruction after total gastrectomy for gastric cancer using a transorally inserted anvil delivery system. Ann Surg Oncol, 2013, 20(9): 2975-2983.
20. Steichen FM. The use of staplers in anatomical side-to-side and functional end-to-end enteroanastomoses. Surgery, 1968, 64(5): 948-953.
21. Inaba K, Satoh S, Ishida Y, et al. Overlap method: novel intracorporeal esophagojejunostomy after laparoscopic total gastrectomy. J Am Coll Surg, 2010, 211(6): e25-e29.
22. Zhou D, Liu QX, Deng XF, et al. Comparison of two different mechanical esophagogastric anastomosis in esophageal cancer patients: A meta-analysis. J Cardiothorac Surg, 2015, 10: 67.
23. Cerfolio RJ, Bryant AS, Hawn MT. Technical aspects and early results of robotic esophagectomy with chest anastomosis. J Thorac Cardiovasc Surg, 2013, 145(1): 90-96.
24. Bongiolatti S, Annecchiarico M, Di Marino M, et al. Robot-sewn Ivor-Lewis anastomosis: Preliminary experience and technical details. Int J Med Robot, 2016, 12(3): 421-426.
25. Kim RH, Takabe K. Methods of esophagogastric anastomoses following esophagectomy for cancer: A systematic review. J Surg Oncol, 2010, 101(6): 527-533.
26. Marano A, Salomone S, Pellegrino L, et al. Robot-assisted esophagectomy with robot-sewn intrathoracic anastomosis (Ivor Lewis): Surgical technique and early results. Updates Surg, 2023, 75(4): 941-952.
27. Markar SR, Karthikesalingam A, Vyas S, et al. Hand-sewn versus stapled oesophago-gastric anastomosis: Systematic review and meta-analysis. J Gastrointest Surg, 2011, 15(5): 876-884.
28. Ben-David K, Sarosi GA, Cendan JC, et al. Technique of minimally invasive Ivor Lewis esophagogastrectomy with intrathoracic stapled side-to-side anastomosis. J Gastrointest Surg, 2010, 14(10): 1613-1618.
29. Schröder W, Raptis DA, Schmidt HM, et al. Anastomotic techniques and associated morbidity in total minimally invasive transthoracic esophagectomy: Results From the EsoBenchmark database. Ann Surg, 2019, 270(5): 820-826.
30. van Heijl M, Gooszen JA, Fockens P, et al. Risk factors for development of benign cervical strictures after esophagectomy. Ann Surg, 2010, 251(6): 1064-1069.
31. Wang S, Lin S, Wang H, et al. Reconstruction methods after radical proximal gastrectomy: A systematic review. Medicine (Baltimore), 2018, 97(11): e0121.
32. Wang H, Hao Q, Wang M, et al. Esophagojejunostomy after laparoscopic total gastrectomy by OrVil™ or hemi-double stapling technique. World J Gastroenterol, 2015, 21(29): 8943-8951.

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