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Hambright et al. Mini-invasive Surg 2024;8:19 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2024.08

Review Open Access

Optimizing the technical results of robotic

esophagectomy: conduit creation and
esophagogastric anastomoses

1
Benjamin Hambright , Benjamin Wei 2
1
Department of Surgery, University of Alabama at Birmingham, Birmingham, AL 35294, USA.
2
Division of Cardiothoracic Surgery, Department of Surgery, University of Alabama at Birmingham Medical Center, Birmingham
VA Medical Center, Birmingham, AL 35233, USA.
Correspondence to: Prof. Benjamin Wei, Division of Cardiothoracic Surgery, Department of Surgery, University of Alabama at
Birmingham Medical Center, Birmingham VA Medical Center, Zeigler Research Building 707, 703 19th Street South,
Birmingham, AL 35233, USA. E-mail: bwei@uabmc.edu

How to cite this article: Hambright B, Wei B. Optimizing the technical results of robotic esophagectomy: conduit creation and
esophagogastric anastomoses. Mini-invasive Surg 2024;8:19. https://dx.doi.org/10.20517/2574-1225.2024.08
Received: 29 Jan 2024 First Decision: 27 Aug 2024 Revised: 7 Sep 2024 Accepted: 19 Sep 2024 Published: 25 Sep 2024

Academic Editors: Itasu Ninomiya, Farid Gharagozloo Copy Editor: Pei-Yun Wang Production Editor: Pei-Yun Wang

Abstract
The esophagectomy, first done over a century ago, has evolved from open procedures to minimally invasive
techniques. As minimally invasive surgery has progressed in both safety and efficiency since its inception, it is
becoming increasingly favored and continues to demonstrate advantageous outcomes over open techniques. In
terms of operative decisions, conduit diameter choice is crucial in esophagectomy. Narrower conduits (≤ 3 cm)
seem to be more efficacious, and less prone to stricture than their wider counterparts (> 5 cm). Perfusion
assessment, notably with indocyanine green (ICG), is still a topic of debate among surgeons with conflicting
opinions on ICG’s impact. There are varying results in leak rates; however, the use of ICG in determining
anastomotic site seems to exert some influence on surgical decision-making. Anastomotic techniques, such as
circular stapling and linear stapling, have shown to be preferred over more traditional hand-sewn methods. At our
institution, a completely robotic approach is used with creation of a 3-4 cm wide conduit and hybrid-type
anastomosis. ICG is used to guide conduit transection and gastrotomy for anastomosis. Our experience shows that
this approach offers an excellent combination of safety and reproducibility.

Keywords: Robotic assisted, minimally invasive, esophagectomy, conduit diameter, indocyanine green, stapled
anastomosis

© The Author(s) 2024. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing,
adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as
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