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Triantafyllou et al. Mini-invasive Surg 2023;7:31 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2023.48

Review Open Access

The evolution of anastomotic techniques in robot-

assisted Ivor Lewis esophagectomy

Tania Triantafyllou 1 , Bruno Sgromo 2
1
Upper Gastrointestinal Surgical Unit, Royal Infirmary of Edinburgh, NHS Lothian, Edinburgh EH16 4SA, UK.
2
Oxford Oesophagogastric Centre, Churchill Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 7LE, UK.
Correspondence to: Dr. Tania Triantafyllou, Upper Gastrointestinal Surgical Unit, Royal Infirmary of Edinburgh, 51 Little France
Cres, Old Dalkeith Rd, Edinburgh EH16 4SA, UK. E-mail: t_triantafilou@yahoo.com

How to cite this article: Triantafyllou T, Sgromo B. The evolution of anastomotic techniques in robot-assisted Ivor Lewis
esophagectomy. Mini-invasive Surg 2023;7:31. https://dx.doi.org/10.20517/2574-1225.2023.48

Received: 23 Apr 2023 First Decision: 24 Aug 2023 Revised: 31 Aug 2023 Accepted: 7 Sep 2023 Published: 11 Sep 2023

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

Abstract
Radical esophagectomy is the cornerstone in the treatment of esophageal cancer combined with perioperative
therapies, whereas patients diagnosed at an early stage may be candidates for endoscopic resection. Minimally
invasive procedures aim to improve the postoperative complications and reduce overall morbidity. The short and
long-term results of the incorporation of robot-assisted esophagectomy in specialised centres worldwide have
been encouraging. The Ivor Lewis technique has become the preferable approach, reaching up to 61% of the
minimally invasive reconstructions in the Western World; however, the percentage of anastomotic leaks remains
problematic. Throughout the last decade, a few modifications of the anastomotic technique have been proposed in
an effort to improve the surgical results of the robot-assisted approach. This review presents the evolving robotic
techniques of performing the esophagogastric anastomosis. An overview of the available approaches will be
discussed with a focus on the intrathoracic anastomosis.

Keywords: Esophageal cancer, Ivor Lewis esophagectomy, minimally invasive esophagectomy, robot-assisted
esophagectomy, anastomotic leak

INTRODUCTION
Esophagectomy is the mainstay of the treatment for resectable esophageal malignancy. Despite the
improved accuracy of the preoperative staging, the thorough selection of patients, the development of

© The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0
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adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as
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