Three-region approach for #106recR lymph node dissection during robot-assisted minimally invasive esophagectomy: a reproducible and easily adoptable technique.

PURPOSE: To develop a standardized and reproducible technique for #106recR lymph node dissection during robot-assisted minimally invasive esophagectomy (RAMIE) and to elucidate its feasibility and clinical outcomes in comparison with those of minimally invasive esophagectomy (MIE).

METHODS

We developed a three-region approach for #106recR lymph node dissection, dividing the operative field into lateral, nerve branch, and medial areas based on the right recurrent laryngeal nerve (RtRN). A total of 140 patients who underwent curative esophagectomy were included: 70 underwent MIE and 70 underwent RAMIE. Dissection time for #106recR lymph nodes and postoperative outcomes were evaluated.

RESULTS

The median dissection time for #106recR lymph nodes was significantly shorter in the RAMIE group than in the MIE group (25 [12-49] vs. 30 [13-35] min, P < 0.01). When divided into early and late phases, the dissection time significantly decreased in the MIE group (P < 0.01), whereas no significant difference was observed in the RAMIE group (P = 0.27). The number of retrieved #106recR lymph nodes and postoperative complications, including recurrent laryngeal nerve palsy, were comparable between the groups.

CONCLUSIONS

This stepwise approach appears feasible in clinical practice and may help promote consistent operative performance, although further validation is needed.