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J Chest Surg

Published online February 7, 2024

Copyright © Journal of Chest Surgery.

Two Cases of Robot-Assisted Totally Minimally Invasive Esophagectomy with Colon Interposition for Gastroesophageal Junction Cancer: Surgical Considerations

Kinam Shin , M.D.1, In Ha Kim , M.D.1, Yun-Ho Jeon , M.D.2, Chung Sik Gong , M.D.3, Chan Wook Kim , M.D., Ph.D.4, Yong-Hee Kim , M.D., Ph.D.1

1Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul; 2Department of Thoracic and Cardiovascular Surgery, Daegu Catholic University School of Medicine, Daegu; Divisions of 3Gastrointestinal Surgery and 4Colon and Rectal Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

Correspondence to:Yong-Hee Kim
Tel 82-2-3010-3580
Fax 82-2-3010-6966
E-mail kimyh67md@hotmail.com
ORCID
https://orcid.org/0000-0003-2177-4876

This case was presented at the third case conference of the Korean Bronchoesophagological Society, which was held at the Hotel Bloom Jeju on August 26, 2023.

Received: September 19, 2023; Revised: November 2, 2023; Accepted: December 7, 2023

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

This case report presents 2 patients with gastroesophageal junction cancer who both underwent totally minimally invasive esophagectomy with colon interposition. Patients 1 and 2, who were 43-year-old and 78-year-old men, respectively, had distinct clinical presentations and medical histories. Patient 1 underwent minimally invasive robotic esophagectomy with a laparoscopic total gastrectomy, colonic conduit preparation, and intrathoracic esophago-colono-jejunostomy. Patient 2 underwent completely robotic total gastrectomy, colon conduit preparation, and intrathoracic esophago–colono–jejunostomy. The primary challenge in colon interposition is assessing colon vascularity and ensuring an adequate conduit length, which is critical for successful anastomosis. In both cases, we used indocyanine green fluorescence angiography to evaluate vascularity. Determining the appropriate conduit is challenging; therefore, it is crucial to ensure a slightly longer conduit during reconstruction. Because totally minimally invasive colon interposition can reduce postoperative pain and enhance recovery, this surgical technique is feasible and beneficial.

Keywords: Colon interposition, Minimally invasive surgical procedures, Robotic surgical procedures, Case reports

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J Chest Surg

Published online February 7, 2024

Copyright © Journal of Chest Surgery.

Two Cases of Robot-Assisted Totally Minimally Invasive Esophagectomy with Colon Interposition for Gastroesophageal Junction Cancer: Surgical Considerations

Kinam Shin , M.D.1, In Ha Kim , M.D.1, Yun-Ho Jeon , M.D.2, Chung Sik Gong , M.D.3, Chan Wook Kim , M.D., Ph.D.4, Yong-Hee Kim , M.D., Ph.D.1

1Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul; 2Department of Thoracic and Cardiovascular Surgery, Daegu Catholic University School of Medicine, Daegu; Divisions of 3Gastrointestinal Surgery and 4Colon and Rectal Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

Correspondence to:Yong-Hee Kim
Tel 82-2-3010-3580
Fax 82-2-3010-6966
E-mail kimyh67md@hotmail.com
ORCID
https://orcid.org/0000-0003-2177-4876

This case was presented at the third case conference of the Korean Bronchoesophagological Society, which was held at the Hotel Bloom Jeju on August 26, 2023.

Received: September 19, 2023; Revised: November 2, 2023; Accepted: December 7, 2023

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

This case report presents 2 patients with gastroesophageal junction cancer who both underwent totally minimally invasive esophagectomy with colon interposition. Patients 1 and 2, who were 43-year-old and 78-year-old men, respectively, had distinct clinical presentations and medical histories. Patient 1 underwent minimally invasive robotic esophagectomy with a laparoscopic total gastrectomy, colonic conduit preparation, and intrathoracic esophago-colono-jejunostomy. Patient 2 underwent completely robotic total gastrectomy, colon conduit preparation, and intrathoracic esophago–colono–jejunostomy. The primary challenge in colon interposition is assessing colon vascularity and ensuring an adequate conduit length, which is critical for successful anastomosis. In both cases, we used indocyanine green fluorescence angiography to evaluate vascularity. Determining the appropriate conduit is challenging; therefore, it is crucial to ensure a slightly longer conduit during reconstruction. Because totally minimally invasive colon interposition can reduce postoperative pain and enhance recovery, this surgical technique is feasible and beneficial.

Keywords: Colon interposition, Minimally invasive surgical procedures, Robotic surgical procedures, Case reports

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