A standardized protocol for robot-assisted minimally invasive esophagectomy: improving efficiency and reducing costs

Area of Science:

• Surgical Oncology
• Minimally Invasive Surgery
• Robotic Surgery

Background:

• Robot-assisted minimally invasive esophagectomy (RAMIE) offers potential advantages for esophageal cancer treatment.
• Lack of standardized protocols leads to outcome variability and increased costs in RAMIE.

Purpose of the Study:

• To evaluate the impact of a standardized RAMIE protocol (CPMD) on perioperative outcomes and costs.
• To compare outcomes before and after the implementation of the CPMD protocol.

Main Methods:

• Retrospective study of 180 patients with esophageal cancer undergoing RAMIE.
• Introduction of a standardized counterclockwise partitioned mediastinal dissection (CPMD) protocol in 114 cases.
• Comparison of operative time, blood loss, complications, and instrument costs between pre- and post-standardization groups.

Main Results:

• Standardized RAMIE (CPMD) significantly decreased median thoracic console time (148 min) and blood loss (62 ml).
• No conversions to open surgery were required; postoperative complications, including recurrent laryngeal nerve paralysis, were reduced.
• Reusing robotic instruments lowered disposable instrument costs by approximately 168,000 JPY ($1050) per case.

Conclusions:

• Implementing a standardized RAMIE protocol (CPMD) enhances efficiency, reduces blood loss, and lowers costs.
• The standardized approach maintains favorable surgical and oncological outcomes.
• This protocol may promote wider adoption of RAMIE for esophageal cancer surgery.