Robert James Cerfolio, MD, FACS, FCCP, Ayesha S

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Technical aspects and early results of robotic esophagectomy with chest anastomosis Robert James Cerfolio, MD, FACS, FCCP, Ayesha S. Bryant, MSPH, MD, Mary T. Hawn, MD, MPH, FACS The Journal of Thoracic and Cardiovascular Surgery Volume 145, Issue 1, Pages 90-96 (January 2013) DOI: 10.1016/j.jtcvs.2012.04.022 Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 A and B, Port placement for the robotic thoracic part of a completely portal robotic (CPR) Ivor Lewis esophagectomy (ILE) using 4 arms, CPR-ILE-4. C is for the camera port and A is for the nonrobotic access port site. The Journal of Thoracic and Cardiovascular Surgery 2013 145, 90-96DOI: (10.1016/j.jtcvs.2012.04.022) Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 A, Intraoperative photograph shows the esophagus being held open by a 5-mm lung grasper that is placed through the most posterior 5 mm, via robotic arm 3. The back row of interrupted sutures is completed. B, Intraoperative photograph depicts the inner layer of the anastomosis being performed using a running 3-0 absorbable suture (knots are outside the lumen) and sewing mucosa to mucosa. Note how robotic arm 2, which has a nontraumatic long-tipped needle forceps, enables the surgeon to maintain tension on the running suture without fraying as the needle driver (in robotic arm 1) is able to place the sutures. C, Intraoperative photo that depicts the second anterior layer of interrupted sutures being placed, which sews the muscular layer of the esophagus to serosa of the gastric conduit using interrupted nonabsorbable sutures. The Journal of Thoracic and Cardiovascular Surgery 2013 145, 90-96DOI: (10.1016/j.jtcvs.2012.04.022) Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 The median operative times for the last 16 patients (all of whom underwent a robotic hand-sewn, 2-layered, thoracic anastomosis). Logarithmic trend line for the thoracic aspect of the operation is shown (R2 = 0.998). The Journal of Thoracic and Cardiovascular Surgery 2013 145, 90-96DOI: (10.1016/j.jtcvs.2012.04.022) Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions