Feasibility And Learning Curve Of Robotic-assisted Minimally Invasive Esophagectomy

Objective: Retrospective analysis have shown that minimally invasive esophagectomy(MIE)is a safe and effective procedure for resectable esophageal cancer.In recent years,Da Vinci surgical robot develops rapidly in the country,as is also applied in minimally invasive treatment for esophageal cancer,which is presenting a broad prospect as well as bringing forward a higher demand for thoracic surgeons in their professional skill.The objective of this study is to explore the feasibility and define a learning curve of robotic assisted esophagectomy by analyzing the clinical data of patients who underwent such surgery performed by a single surgical team in Fujian Medical University Union Hospital.Methods: A retrospective study was conducted on the clinical data of 16 cases of robotic-assisted minimally invasive radical esophagectomy and 42 cases of conventional minimally invasive esophagectomy(MIE,also known as thoracolaparoscopic radical esophagectomy)performed by a single surgical team in Fujian Medical University Union Hospital during August 2016 to January 2017,patients underwent different surgical procedures were compared in concern to the index including preoperative general information,operation time,amount of bleeding,lymph nodes dissected,mediastinum lymph nodes,recurrent laryngeal lymph nodes,postoperative length of hospital stay.By analyzing the surgical outcomes of these two procedures and robotic-assisted radical esophagectomy in different time,we assessed the feasibility of robotic-assisted radical esophagectomy and defined its learning curve.Results: Fifty-eight patients(16 of RAMIE,42 of MIE)were included in this study.No statistical significance was observed between the two groups of operation time,amount of bleeding,and number of lymph nodes dissected[(356.9±66.2)min vs(372.3±86.8)min,P=0.524;(138.1±77.8)ml vs(121.0±81.5)ml,P=0.440;(38.1±15.5)vs(40.5±14.3),P=0.771].R0 resection was performed in all patients,no conversion to open thoracotomy were required.There were no statistical difference between two groups in preoperative general information,means of lymph node dissection,postoperative length of hospital stay,pathological type and staging,rate of postoperative complications(P>0.05).Sixteen patients underwent RAMIE included 8men and 8 women with the mean age of(64.1±9.8)years,mean operation time is(356.9±66.2)minutes,mean amount of blood loss is(138.1±77.8)ml.They were divided into three groups following the time order of surgery,group A,B and C with5,5 and 6 patients included respectively.No statistical difference were identified among these three groups in age,BMI,tumor location,amount of blood loss,total lymph node dissected,mediastinum lymph node,recurrent laryngeal lymph node and postoperative length of hospital stay(P>0.05).Neither did the statistical difference appeared in postoperative complication(P=0.813).However,the time of operation indicated significant difference(P=0.019),further multiple comparison revealed that time of group A is significantly longer than that of group B and C(PA-B=0.029,PA-C=0.007),while group B also took longer time group C,but it was insignificant(PB-C=0.558).Learning curve analysis showed that after 7 RAMIE cases,the operation time would be shortened to that of MIE procedure and reached a plateau.Conclusions: RAMIE is a safe and feasible procedure,whose short term postoperative effects are generally equivalent to conventional thoracolaparoscopic procedure.The transition from MIE to RAMIE is rapid for a surgeon with rich thoracoscopic experience.After 7 cases,operation time could reach a relatively stable level.