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Ninomiya et al. Mini-invasive Surg 2022;6:33 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2022.12

Technical Note Open Access

Novel surgical technique of robot-assisted

thoracoscopic esophagectomy in the lateral
decubitus position

Itasu Ninomiya, Koichi Okamoto

Department of Gastroenterological Surgery, Kanazawa University, Kanazawa, Ishikawa 920-8641, Japan.
Correspondence to: Pro. Itasu Ninomiya, Department of Gastroenterological Surgery, Kanazawa University, 13-1 Takaramachi,
Kanazawa, Ishikawa 920-8641, Japan. E-mail: ninoitasu@gmail.com

How to cite this article: Ninomiya I, Okamoto K. Novel surgical technique of robot-assisted thoracoscopic esophagectomy in the
lateral decubitus position. Mini-invasive Surg 2022;6:33. https://dx.doi.org/10.20517/2574-1225.2022.12
Received: 20 Jan 2022 First Decision: 14 Mar 2022 Revised: 17 Mar 2022 Accepted: 29 Mar 2022 Published: 1 Jun 2022

Academic Editor: Giulio Belli Copy Editor: Peng-Juan Wen Production Editor: Peng-Juan Wen

Abstract
We performed robot-assisted thoracoscopic esophagectomy in lateral decubitus position (LDP) with camera
rotation and manual hand control assignment to reproduce the visualization and manipulation of open
esophagectomy or thoracoscopic esophagectomy in LDP. Four robotic ports and two 12 mm assistant ports were
placed. The camera image for the operator was vertically and horizontally inverted by camera rotation to create an
operative view similar to that achieved under open thoracotomy. We used a forward-oblique viewing endoscope
with a 30° down-facing orientation. The mediastinal view was obtained by single lung ventilation, artificial
pneumothorax by carbon dioxide insufflation, and trachea retraction by the assistant. The right and left hands were
assigned to any combination of two out of the three arms depending on the situation. The remaining arm was used
as an assistant to create an adequate surgical view. The robotic platform is useful to manage aortic injury by direct
suturing.

Keywords: Robotic surgery, esophageal cancer, lateral decubitus position (LDP)

INTRODUCTION
Esophagectomy with regional lymphadenectomy plays a major role in esophageal cancer treatment.
Thoracoscopic and laparoscopic minimally invasive esophagectomy procedures have been performed to
reduce the surgical damage caused by esophageal surgery . Recently, robot-assisted thoracoscopic
[1-3]

© The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0
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