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Safe introduction of hinotori™ for robot-assisted minimally invasive esophagectomy as the second robotic system
Shintaro Okumura1, Shoichi Kitano1, Shigeru Tsunoda2
1Department of Gastrointestinal Surgery, Kyoto University Hospital, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
Background:
The hinotori™ Surgical Robot System is an alternative to the da Vinci Surgical System for performing robot-assisted minimally invasive esophagectomy (RAMIE). We introduce our setup and surgical procedure for RAMIE using the hinotori™ Surgical Robot System (H-RAMIE) and present its outcomes and the team's familiarization with RAMIE using the second robotic system.
Methods:
With the patient in the left semiprone position, the patient cart was rolled in from the right cranial side of the patient. Teaching pivots were optimized for upper mediastinal dissection. An assistant's sealing device was frequently utilized for middle and lower mediastinal dissections. In addition to the analysis of all the experienced cases, a matched retrospective comparative analysis of short-term outcomes was performed between H-RAMIE and RAMIE using the da Vinci Xi (D-RAMIE). The learning curves of the cockpit time, setting time, and ratio of idle time-to-cockpit time of H-RAMIE were analyzed using the cumulative sum method.
Results:
H-RAMIE was performed in 45 patients, including 11 salvage esophagectomies. The incidences of postoperative complications of Clavien-Dindo (CD) grades ≥ 2 and ≥ 3a were 55.6 and 20%, respectively; no postoperative mortality was observed. The median postoperative hospital stay was 25 days. By matching, 29 cases of H-RAMIE and D-RAMIE were included in the comparative analysis. H-RAMIE demonstrated a longer thoracic part time than D-RAMIE; however, no significant differences were observed between both groups regarding the incidence of postoperative complications of CD grades ≥ 2 and ≥ 3a, incidence of recurrent laryngeal nerve palsy of all grades or the length of postoperative hospital stay. Learning curve analyses suggested that approximately 9-13 cases were required to reach an efficiency plateau in H-RAMIE.
Conclusions:
The hinotori™ can be safely introduced as the second robotic system for RAMIE, requiring approximately 9-13 cases to reach an efficiency plateau in an institution with experience in RAMIE.
