Minimally invasive esophagectomy

Summary

Background

Minimally invasive techniques have replaced the conventional open approach in many operations. For esophagectomy, it took quite a long time to become routine even in centers. The aim of this review was to demonstrate history and current status of minimally invasive esophagectomy and also robotic-assisted esophagectomy with its associated techniques.

Methods

Selected literature on minimally invasive surgery for esophageal cancer was identified using a PubMed search for the period 1990–2018 with the search terms esophagectomy, minimal invasive, robotic, indocyanine fluorescein, enhanced recovery after surgery (ERAS), fast-track, nerve monitoring and its permutations.

Results

Within the last two decades minimally invasive esophagectomy has found its way into clinical practice. It reduces perioperative morbidity with equivalent oncological outcome. It allows for better pulmonary results, less blood loss, less pain, and better quality of life. If robotic assisted esophagectomy helps to further improve the results is currently under investigation. Fast-track protocols have proven their value. Intraoperative nerve monitoring and indocyanine green fluorescein imaging of the perfusion of the gastric tube can lower perioperative complications.

Conclusions

Minimally invasive surgery for esophageal malignancies offers advantages when performed in an environment with sufficient expertise and caseload. Whether robotic-assisted minimally invasive esophagectomy further improves the results has to be investigated in the future. Intraoperative nerve monitoring and visualization of the graft perfusion with indocyanine green fluorescein should be used where available. Enhanced recovery protocols after surgery have become standard.

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