A standardized linear-stapled side-to-side anastomotic technique in robot-assisted Ivor Lewis esophagectomy: a...

Early experiences with robotic-assisted esophagectomy showed disappointing anastomotic outcomes when techniques were directly translated from open or thoracoscopic surgery. Among intrathoracic anastomotic options in robot-assisted Ivor Lewis esophagectomy (RAMIE-IL), emerging data suggest lower complication rates with the linear stapled side-to-side technique. This method was adopted at our institution in 2018. Here, we present our outcomes and describe our standardized linear-stapled side-to-side anastomosis for RAMIE-IL. The primary objective of this study was to detail the surgical technique and evaluate postoperative outcomes of a linear-stapled side-to-side anastomosis in RAMIE-IL. This retrospective cohort study used prospectively collected registry data of all consecutive patients undergoing RAMIE-IL with an intrathoracic linear-stapled side-to-side anastomosis at ZGT Almelo, The Netherlands. All patients from inception (July 1st, 2018) until November 15th, 2025, were included. Data were obtained from the Dutch Upper GI Cancer Audit (DUCA) registry. 350 consecutive patients were included. Mean age was 66 years, 70% were male and 44% had an ASA-class of 3 or more. Length of ICU stay was median 1 days. Length of hospital stay was median 7 days. Overall anastomotic leak rate was 4%. Overall rate of all Clavien-Dindo ≥ 3 complications was 14%. Readmission rate within 30 days was 12.5%. 30-day mortality rate was 1.7%. The presented linear-stapled side-to-side anastomotic technique is feasible and associated with a low rate of anastomotic complications in the studied cohort.