0000000000088499
AUTHOR
Richard Van Hillegersberg
showing 12 related works from this author
Robot-assisted cervical esophagectomy: first clinical experiences and review of the literature
2020
Summary Pulmonary complications, and especially pneumonia, remain one of the most common complications after esophagectomy for esophageal cancer. These complications are reduced by minimally invasive techniques or by avoiding thoracic access through a transhiatal approach. However, a transhiatal approach does not allow for a full mediastinal lymphadenectomy. A transcervical mediastinal esophagectomy avoids thoracic access, which may contribute to a decrease in pulmonary complications after esophagectomy. In addition, this technique allows for a full mediastinal lymphadenectomy. A number of pioneering studies have been published on this topic. Here, the initial experience is presented as wel…
Hybrid minimally invasive esophagectomy for esophageal cancer : less is more
2019
In a recently published multi-center randomized controlled trial ( New England Journal of Medicine 2019;380:152-162) Christophe Mariette and colleagues compared open transthoracic esophagectomy to hybrid esophagectomy (open thoracic phase, laparoscopic abdominal phase) for patients with resectable cancer of the middle or lower third of the esophagus (MIRO trial) (1).
Worldwide Techniques and Outcomes in Robot-assisted Minimally Invasive Esophagectomy (RAMIE): Results From the Multicenter International Registry
2022
OBJECTIVE: This international multicenter study by the Upper GI International Robotic Association aimed to gain insight in current techniques and outcomes of RAMIE worldwide.BACKGROUND: Current evidence for RAMIE originates from single-center studies, which may not be generalizable to the international multicenter experience.METHODS: Twenty centers from Europe, Asia, North-America, and South-America participated from 2016 to 2019. Main endpoints included the surgical techniques, clinical outcomes, and early oncological results of ramie.RESULTS: A total of 856 patients undergoing transthoracic RAMIE were included. Robotic surgery was applied for both the thoracic and abdominal phase (45%), o…
Technical details of the abdominal part during full robotic-assisted minimally invasive esophagectomy
2020
Abstract The full robotic-assisted minimally invasive esophagectomy (RAMIE) is an upcoming approach in the treatment of esophageal and junctional cancer. Potential benefits are seen in angulated precise maneuvers in the abdominal part as well as in the thoracic part, but due to the novelty of this approach the optimal setting of the trocars, the instruments and the operating setting is still under debate. Hereafter, we present a technical description of the ‘Mainz technique’ of the abdominal part of RAMIE carried out as Ivor Lewis procedure. Postoperative complication rate and duration of the abdominal part of 100 consecutive patients from University Medical Center in Mainz are illustrated.…
Robot-assisted and conventional minimally invasive esophagectomy are associated with better postoperative results compared to hybrid and open transth…
2021
BACKGROUND Currently 4 surgical techniques are performed for transthoracic esophagectomy (open esophagectomy (OE), hybrid esophagectomy (HE), conventional minimally invasive esophagectomy (MIE) and robot assisted minimally invasive esophagectomy (RAMIE). Aim of this study was to compare these 4 different esophagectomy approaches regarding postoperative complications and short term oncologic outcomes. METHODS Between 2008 and 2019, consecutive patients who underwent esophagectomy with gastric conduit reconstruction were included in this single center study. The primary outcome of this study was the incidence of postoperative complications. RESULTS Overall 422 patients (OE (n = 107), HE (n = …
PS02.010: ESTABLISHMENT OF THE UPPER GI INTERNATIONAL ROBOTIC ASSOCIATION (UGIRA)
2018
Abstract Background Robot-assisted surgery is increasingly performed for both benign and malignant upper gastro-intestinal disease. However, no global consensus exists regarding exact techniques and implementation methods of robotic esophageal and gastric surgery. To facilitate the effective implementation and advancement of these procedures, evidence based guidelines should be generated. In this context, the ‘Upper GI International Robotic Association’ (UGIRA) was established in 2017. Until now, 20 experienced robotic surgeons from 10 different countries in Europe (The Netherlands, Germany, United Kingdom, Denmark), Asia (Japan, Hong Kong, North-Korea, Taiwan), North-America (United States…
Robotic-assisted minimally invasive esophagectomy (RAMIE) for esophageal cancer training curriculum—a worldwide Delphi consensus study
2021
Summary Background Structured training protocols can safely improve skills prior initiating complex surgical procedures such as robotic-assisted minimally invasive esophagectomy (RAMIE). As no consensus on a training curriculum for RAMIE has been established so far it is our aim to define a protocol for RAMIE with the Delphi consensus methodology. Methods Fourteen worldwide RAMIE experts were defined and were enrolled in this Delphi consensus project. An expert panel was created and three Delphi rounds were performed starting December 2019. Items required for RAMIE included, but were not limited to, virtual reality simulation, wet-lab training, proctoring, and continued monitoring and educa…
Robotic Esophagectomy: The European Experience
2021
In 2003, robot-assisted minimally invasive thoraco-laparoscopic esophagectomy (RAMIE) was developed to overcome the technical limitations of minimally invasive esophagectomy (MIE). Robotic surgery benefits from a stable three-dimensional, magnified view and articulated instruments enabling precise dissection with 7 degrees of freedom of movement. At the time of introduction of RAMIE in 2003, there were no robotic endowristed coagulating instruments available. The dissection of the greater curvature along the gastroepiploic vessels with a rigid robotic ultrasonic scalpel did not add to conventional laparoscopic dissection. Furthermore, the dexterity of the robotic arms was insufficient to re…
Surgical anatomy of the upper esophagus related to robot-assisted cervical esophagectomy
2021
Abstract Robot-assisted cervical esophagectomy (RACE) enables radical surgery for tumors of the middle and upper esophagus, avoiding a transthoracic approach. However, the cervical access, narrow working space, and complex topographic anatomy make this procedure particularly demanding. Our study offers a stepwise description of appropriate dissection planes and anatomical landmarks to facilitate RACE. Macroscopic dissections were performed on formaldehyde-fixed body donors (three females, three males), according to the surgical steps during RACE. The topographic anatomy and surgically relevant structures related to the cervical access route to the esophagus were described and illustrated, a…
Technical details of the hand-sewn and circular-stapled anastomosis in robot-assisted minimally invasive esophagectomy.
2020
SUMMARY The circular mechanical and hand-sewn intrathoracic anastomosis are most often used in robot-assisted minimally invasive esophagectomy (RAMIE). The aim of this study was to describe the technical details of both techniques that were pioneered in two high volume centers for RAMIE. A prospectively maintained database was used to identify patients with esophageal cancer who underwent RAMIE with intrathoracic anastomosis. The primary outcome was anastomotic leakage, which was analyzed using a moving average curve. For the hand-sewn anastomosis, video recordings were reviewed to evaluate number of sutures and distances between the anastomosis and the longitudinal staple line or gastric c…
The da Vinci Xi Robotic Four-Arm Approach for Robotic-Assisted Minimally Invasive Esophagectomy
2018
AbstractRobotic surgery is gaining importance in complex thoracoscopic surgery, such as robotic-assisted minimally invasive esophagectomy (RAMIE). The RAMIE procedure was designed using the first generation of the robotic system. The latest da Vinci Xi system has substantially increased the dexterity, especially designed for multiquadrant surgery. The original three-arm RAMIE approach was modified including the robotic four-arm use for the thoracoscopic and laparoscopic part of the operation. This extended approach (four-arm RAMIE approach) provides more flexibility and raises the independence of the surgeon.
Surgical robotics for esophageal cancer
2018
We present an update on robotic techniques and their advantages and use in esophageal cancer surgery. Recent work has shown tremendous progress in robotic-assisted minimally invasive esophagectomy (RAMIE) and lymphadenectomy for esophageal cancer, as well as benefits of robotic surgery in high upper esophageal tumors and T4b disease. We discuss the different RAMIE techniques, especially for intrathoracic anastomosis. The ongoing ROBOT trial had demonstrated superiority of robotic esophageal cancer surgery over open esophagectomy. There are various putative technical advantages of RAMIE over minimally invasive esophagectomy, which need to be proven in future trials.