To report the experience of pretreatment-facilitated robot intrathoracic layered anastomosis (PRILA) .

Patients with esophageal cancer proved by biopsy and willing to accept robot-assisted minimally invasive esophagectomy (RAMIE) were included in this study. The pretreatments before anastomosis included the following procedures. Firstly, we used the sternal angle as a marker to confirm the length of the gastric conduit so that we could construct the conduit outside the body. Secondly, cold scissors, rather than the electrocoagulation equipment, were used in making the gastrostomy. Thirdly, the gastric conduit was carefully packaged with single-layered gauze before we move it into the thoracic cavity. Lastly, an intrathoracic clamp was placed on the proximal esophageal stump to reduce the bleeding of the stump. An interview was performed every half-year after the surgery to track the postoperative outcomes.

Between September 2018 and July 2019, 12 patients with esophageal cancer received PRILA for tumor resection and digestive tract reconstruction. All the patients achieved R0 resection, and no patient suffered from an anastomotic leakage. The mean length of postoperative stay was 9.9 day. All patients could receive semiliquid diet when discharged. No relapse or metastasis happened in the first year after the surgery.

PRILA is a safe and feasible procedure with favorable surgical outcomes. The pretreatment procedures provide us a clean surgical field so that the anastomosis could be performed fluently and accurately. It provides surgeons a new strategy to handle the challenges of the intrathoracic robotic anastomosis.