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Ann Surg. 2020 Nov 09; doi: 10.1097/SLA.0000000000004550. Epub 2020 Nov 09.

Worldwide Techniques and Outcomes in Robot-Assisted Minimally Invasive Esophagectomy (RAMIE): Results from the Multicenter International Registry.

Annals of surgery

B Feike Kingma, Peter P Grimminger, Pieter C van der Sluis, Marc J van Det, Ewout A Kouwenhoven, Yin-Kai Chao, Chun-Yi Tsai, Hans F Fuchs, Christiane J Bruns, Inderpal S Sarkaria, James D Luketich, Jan W Haveman, Boudewijn van Etten, Philip W Chiu, Shannon M Chan, Philippe Rouanet, Anne Mourregot, Jens-Peter Hölzen, Rubens A Sallum, Ivan Cecconello, Jan-Hendrik Egberts, Frank Benedix, Mark I van Berge Henegouwen, Suzanne S Gisbertz, Daniel Perez, Kristina Jansen, Michal Hubka, Donald E Low, Matthias Biebl, Johann Pratschke, Paul Turner, Kish Pursnani, Asif Chaudry, Myles Smith, Elena Mazza, Paolo Strignano, Jelle P Ruurda, Richard van Hillegersberg,


  1. University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands.
  2. University Medical Center of the Johannes Gutenberg University, Mainz, Germany.
  3. ZGT Almelo, Almelo, The Netherlands.
  4. Chang Gung Memorial Hospital-Linko, Chang Gung University, Taoyuan, Taiwan.
  5. University of Cologne, Cologne, Germany.
  6. University Pittsburgh Medical Center, Pittsburgh, United States of America.
  7. University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
  8. The Chinese University of Hong Kong, Division of Upper GI and Metabolic Surgery, Department of Surgery, Faculty of Medicine, Hong Kong.
  9. Montpellier Cancer Institute, Montpellier, France.
  10. Universitätsklinikum Münster, Münster, Germany.
  11. University of São Paulo, São Paulo, Brazil.
  12. Universitätsklinikum Kiel, Kiel, Germany.
  13. University Hospital Magdeburg, Magdeburg, Germany.
  14. Amsterdam UMC Cancer Center Amsterdam, University of Amsterdam, The Netherlands.
  15. University Hospital Eppendorf, Hamburg, Germany.
  16. Virginia Mason Hospital, Seattle, United States of America.
  17. Charite University Medicine Berlin, Berlin, Germany.
  18. Lancashire Teaching Hospitals, Preston, United Kingdom.
  19. The Royal Marsden, London, United Kingdom.
  20. Città della Salute e della Scienza, Università degli Studi di Torino, Turin, Italy.

PMID: 33177354 DOI: 10.1097/SLA.0000000000004550


OBJECTIVE: This international multicenter study by the Upper GI International Robotic Association (UGIRA) aimed to gain insight in current techniques and outcomes of RAMIE worldwide.

BACKGROUND: Current evidence for RAMIE originates from single-center studies, which may not be generalizable to the international multicenter experience.

METHODS: 20 centers from Europe, Asia, North-America, and South-America participated from 2016- 2019. Main endpoints included the surgical techniques, clinical outcomes, and early oncological results of RAMIE.

RESULTS: A total of 856 patients undergoing transthoracic RAMIE were included. Robotic surgery was applied for both the thoracic and abdominal phase (45%), only the thoracic phase (49%), or only the abdominal phase (6%). In most cases, the mediastinal lymphadenectomy included the low para-esophageal nodes (n=815, 95%), subcarinal nodes (n = 774, 90%), and paratracheal nodes (n = 537, 63%). When paratracheal lymphadenectomy was performed during an Ivor Lewis or a McKeown RAMIE procedure, recurrent laryngeal nerve injury occurred in 3% and 11% of patients, respectively. Circular stapled (52%), hand-sewn (30%), and linear stapled (18%) anastomotic techniques were used. In Ivor Lewis RAMIE, robot-assisted hand-sewing showed the highest anastomotic leakage rate (33%), while lower rates were observed with circular stapling (17%) and linear stapling (15%). In McKeown RAMIE, a hand-sewn anastomotic technique showed the highest leakage rate (26%), followed by linear stapling (18%) and circular stapling (6%).

CONCLUSION: This study is the first to provide an overview of the current techniques and outcomes of transthoracic RAMIE worldwide. Although these results indicate high quality of the procedure, the optimal approach should be further defined.

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