Nicholas R Hess1, Nabil P Rizk2, James D Luketich3, Inderpal S Sarkaria3. 1. University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. 2. Division of Thoracic Surgery, John Theurer Cancer Center, Hackensack, NJ, USA. 3. Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Abstract
OBJECTIVE: Finding of a significant replaced left hepatic artery (RLHA) during esophagectomy is relatively rare, with an incidence of approximately 5%. Sparing of the artery may be required to avoid complications of liver ischemia. Robotic assistance during esophagectomy may provide a technically superior method of artery preservation with minimally invasive approaches. METHODS: This is a retrospective case series of patients undergoing robotic-assisted minimally invasive esophagectomy (RAMIE) identified to have a significant RLHA at time of surgery. RESULTS: Five patients with a significant RLHA were identified from a series of over 100 RAMIE operations. Preservation of RLHA was accomplished in all cases without need for conversion, no intra-operative complications, and no post-operative liver dysfunction. The stomach was suitable and used for conduit reconstruction in all patients. CONCLUSIONS: Sparing of the RLHA during RAMIE is feasible and effective. The robotic assisted approach may obviate the need for open conversion during these complex minimally invasive operations.
OBJECTIVE: Finding of a significant replaced left hepatic artery (RLHA) during esophagectomy is relatively rare, with an incidence of approximately 5%. Sparing of the artery may be required to avoid complications of liver ischemia. Robotic assistance during esophagectomy may provide a technically superior method of artery preservation with minimally invasive approaches. METHODS: This is a retrospective case series of patients undergoing robotic-assisted minimally invasive esophagectomy (RAMIE) identified to have a significant RLHA at time of surgery. RESULTS: Five patients with a significant RLHA were identified from a series of over 100 RAMIE operations. Preservation of RLHA was accomplished in all cases without need for conversion, no intra-operative complications, and no post-operative liver dysfunction. The stomach was suitable and used for conduit reconstruction in all patients. CONCLUSIONS: Sparing of the RLHA during RAMIE is feasible and effective. The robotic assisted approach may obviate the need for open conversion during these complex minimally invasive operations.
Authors: Alexander Wilhelm; Fabio Nocera; Fiorenzo V Angehrn; Martin Bolli; Romano Schneider; Luca Koechlin; Diana L Daume; Lana Fourie; Daniel Steinemann; Markus von Flüe; Ralph Peterli Journal: Surg Endosc Date: 2021-02-01 Impact factor: 4.584