Unplanned intraoperative events and complications of robot-assisted minimally invasive esophagectomy

doi:10.3877/cma.j.issn.2095-8773.2019.01.012

Abstract

Abstract:

Robot-assisted minimally invasive esophagectomy(RAMIE)has the same safety and efficacy as traditional open surgery and thoracoscopic-laparoscopic esophagectomy, and is increasingly used in clinical operations. However, unplanned intraoperative events will inevitably occur in the early stage of RAMIE. In this paper, the types, occurrence rates and treatment methods of unplanned events in RAMIE are described, and the classification and treatment strategies of postoperative complications are also sorted out, so as to improve the understanding of intraoperative unplanned events and complications in RAMIE, to avoid unplanned events and reduce the harm caused by unplanned intraoperative events and serious complications as far as possible.

Key words: Esophageal cancer, Robot-assisted minimally invasive esophagectomy, Unplanned events, Complications

Xufeng Guo, bin Li, Xiaobing Zhang, Yang Yang, Teng Mao, Yifeng Sun, Zhigang Li. Unplanned intraoperative events and complications of robot-assisted minimally invasive esophagectomy[J]. Chinese Journal of Thoracic Surgery(Electronic Edition), 2019, 06(01): 56-62.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhxbwkdzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-8773.2019.01.012

https://zhxbwkdzzz.cma-cmc.com.cn/EN/Y2019/V06/I01/56

Figures/Tables 6

References 30

1	Guo X, Ye B, Yang Y, et al. Impact of unplanned events on early postoperative results of minimally invasive esophagectomy[J]．Thorac Cancer，2018，9(1)：94-98.
2	中国医师协会食管外科专家委员会．微创食管癌切除术(minimally invasive esophagectomy，MIE)专家共识[J]．中华胸心血管外科杂志，2013，29(7)：385-387.
3	Low DE, Alderson D, Cecconello I, et al. International consensus on standardization of data collection for complications associated with Esophagectomy[J]. Ann Surg，2015，262(2)：286-294.
4	Zaninotto G, Low DE. Complications after esophagectomy: it is time to speak the same language[J]. Dis Esophagus，2016，29(6)：580-582.
5	Galvani CA, Gorodner MV, Moser F, et al. Robotically assisted laparoscopic transhiatal esophagectomy[J]. Surg Endosc，2008，22(1)：188-195.
6	Coker AM, Barajas-Gamboa JS, Cheverie J, et al. Outcomes of robotic-assisted transhiatal esophagectomy for esophageal cancerafter neoadjuvant chemoradiation[J]. J Laparoendosc Adv Surg Tech A，2014，24(2)：89-94.
7	Mori K, Yamagata Y, Wada I, et al. Robotic-assisted totally transhiatal lymphadenectomy in the middle mediastinum for esophageal cancer[J]. J Robot Surg, 2013，7：385-387.
8	Dunn DH, Johnson EM, Morphew JA, et al.Robot-assisted transhiatal esophagectomy: A 3-year single-center experience[J]．Dis Esophagus, 2013，26(2)：159-166.
9	Hodari A, Park KU, Lace B, et al. Robot-assisted minimally invasive Ivor Lewis esophagectomy with real-time perfusion assessment[J]. Ann Thorac Surg，2015，100(3)：947-952.
10	Cerfolio RJ, Bryant AS, Hawn MT. Technical aspects and early results of robotic esophagectomy with chest anastomosis[J]．J Thorac Cardiovasc Surg, 2013，145(1)：90-96.
11	Meredith K, Huston J, Andacoglu O, et al. Safety and feasibility of robotic-assisted Ivor-Lewis esophagectomy[J]. Dis Esophagus，2018，31(7)．doi: 10.1093/dote/doy005.
12	Zhang Y, Xiang J, Han Y, et al. Initial experience of robot-assisted Ivor-Lewis esophagectomy: 61 consecutive cases from a single Chinese institution[J]. Dis Esophagus，2018，31(12). doi: 10.1093/dote/doy048.
13	Wang WP, Chen LQ, Zhang HL, et al. Modified intrathoracic esophagogastrostomy with minimally invasive robot-assisted Ivor-Lewis esophagectomy for cancer[J]. Dig Surg，2018，1-8.
14	Kernstine KH, DeArmond DT, Shamoun DM, et al.The first series of completely robotic esophagectomies with three-field lymphadenectomy: initial experience[J]. Surg Endosc，2007, 21(12)：2285-2292.
15	Verhage RJ, Hazebroek EJ, Boone J, et al. Minimally invasive surgery compared to open procedures in esophagectomy for cancer: a systematic review of the literature[J]. Minerva Chir，2009，64(2)：135-146.
16	Weksler B, Sharma P, Moudgill N, et al. Robot-assisted minimally invasive esophagectomy is equivalent to thoracoscopic minimally invasive esophagectomy [J]. Dis Esophagus，2012，25(5)：403-409.
17	van der Sluis PC, Ruurda JP, Verhage RJ, et al. Oncologic long-term results of robot-assisted minimally invasive thoraco-laparoscopic esophagectomy with two-field lymphadenectomy for esophageal cancer[J]. Ann Surg Oncol，2015，22(Suppl3): S1350-S1356.
18	Puntambekar S, Kenawadekar R, Kumar S, et al. Robotic transthoracic esophagectomy[J]. BMC Surg，2015，15：47.
19	易俊，熊磊，李德闽，等．达芬奇机器人在食管癌外科治疗中的应用[J]．中国胸心血管外科临床杂志，2015，22(10)：910-913.
20	Park SY, Kim DJ, Yu WS, et al.Robot-assisted thoracoscopic esophagectomy with extensive mediastinal lymphadenectomy: experience with 114 consecutive patients with intrathoracic esophageal cancer[J]．Dis Esophagus，2016, 29(4)：326-332.
21	谭子辉，张旭，王欣烨，等．机器人辅助食管癌根治术近期疗效分析[J]．中华胃肠外科杂志，2016，19(9)：995-998.
22	Chiu P W, Teoh A Y, Wong, V W, et al. Robotic-assisted minimally invasive esophagectomy for treatment of esophageal carcinoma[J]．J Robot Surg，2017，11(2): 193-199.
23	Somashekhar SP, Jaka RC. Total (transthoracic and transabdominal) robotic radical three-stage esophagectomy-initial Indian Experience[J]. Indian J Surg，2017，79(5)：412-417.
24	Chao YK, Hsieh MJ, Liu YH, et al. Lymph node evaluation in robot-assisted versus video-assisted thoracoscopic esophagectomy for esophageal squamous cell carcinoma: a propensity-matched analysis[J]. World J Surg，2018，42(2)：590-598.
25	He H, Wu Q, Wang Z, et al. Short-term outcomes of robot-assisted minimally invasive esophagectomy for esophageal cancer: a propensity score matched analysis[J]. J Cardiothorac Surg，2018，13(1)：52.
26	Deng HY, Luo J, Li SX, et al.Does robot-assisted minimally invasive esophagectomy really have the advantage of lymphadenectomy over video-assisted minimally invasive esophagectomy in treating esophageal squamous cell carcinoma A propensity score-matched analysis based on short-term outcomes[J]. Dis Esophagus，2018.doi: 10.1093/dote/doy110.
27	Zhang X, Su Y, Yang Y，et al. Robot assisted esophagectomy for esophageal squamous cell carcinoma[J]．J Thorac Dis，2018，10(6)：3767-3775.
28	郭旭峰，李志刚．机器人辅助微创食管癌根治术的应用进展[J]．中华外科杂志，2018，56(4)：312-315.
29	van der Sluis PC, Ruurda JP, van der Horst S，et al. Robot-assisted minimally invasive thoraco-laparoscopic esophagectomy versus open transthoracic esophagectomy for resectable esophageal cancer, a randomized controlled trial (ROBOT trial)[J]．Trials, 2012，13：230.
30	American Thoracic Society, Infectious Diseases Society of America. Guidelines for the management of adults with hospital-acquired, ventilator-associated, and healthcare-associated pneumonia[J]. Am J Respir Crit Care Med，2005，171(4)：388-416.

术中非计划事件		n(%)
机械因素		2(0.59)
?	机械臂功能障碍	2(0.59)
非机械因素		38(11.27)
术者因素		13(4.05)
?	穿刺器刺入肺组织	3(0.87)
?	术中出血	3(0.87)
?	喉返神经断裂	3(0.87)
?	气道损伤	2(0.59)
?	胃网膜右血管弓损伤	2(0.59)
患者因素		25(7.23)
?	原发肿瘤或(和)转移淋巴结R2切除	13(3.76)
?	胸腔或(和)腹腔粘连	8(2.31)
?	心律失常	2(0.59)
?	支气管痉挛合并血压下降	1(0.29)
?	心肌梗死	1(0.29)

术中非计划事件		n(%)
机械因素		2(0.59)
?	机械臂功能障碍	2(0.59)
非机械因素		38(11.27)
术者因素		13(4.05)
?	穿刺器刺入肺组织	3(0.87)
?	术中出血	3(0.87)
?	喉返神经断裂	3(0.87)
?	气道损伤	2(0.59)
?	胃网膜右血管弓损伤	2(0.59)
患者因素		25(7.23)
?	原发肿瘤或(和)转移淋巴结R2切除	13(3.76)
?	胸腔或(和)腹腔粘连	8(2.31)
?	心律失常	2(0.59)
?	支气管痉挛合并血压下降	1(0.29)
?	心肌梗死	1(0.29)

中转原因	n(%)
胸腔或(和)腹腔粘连	5(1.45)
暴露不佳而中转开腹	5(1.45)
原发肿瘤或(和)转移淋巴结R2切除	3(0.87)
腔镜下难以控制出血	2(0.59)
心律失常致循环不稳定	1(0.29)

中转原因	n(%)
胸腔或(和)腹腔粘连	5(1.45)
暴露不佳而中转开腹	5(1.45)
原发肿瘤或(和)转移淋巴结R2切除	3(0.87)
腔镜下难以控制出血	2(0.59)
心律失常致循环不稳定	1(0.29)

术中非计划事件		处理方法	n
机械因素		?	2
?	机械臂功能障碍	改为传统腔镜手术	2
非机械因素		?	38
术者因素		?	13
?	穿刺器刺入肺组织	修补肺破裂部位	3
?	术中出血	腔镜下止血/失败则中转开放	3
?	喉返神经断裂	腔镜下prolene滑线缝合重建	3
?	气道损伤	腔镜下强生薇乔线缝合	2
?	胃网膜右血管弓损伤	二期结肠代/再血管化	2
患者因素		?	25
?	原发肿瘤或(和)转移淋巴结R2切除	姑息手术	13
?	胸腔或(和)腹腔粘连	尝试分离/失败则中转开放	8
?	心律失常	药物治疗/循环不稳则终止手术	2
?	支气管痉挛合并血压下降	药物治疗后稳定	1
?	心肌梗死	终止手术和主动脉球囊反搏	1

Please choose a citation manager

Content to export