Esofagectomía tipo Ivor-Lewis robótica

Esofagectomía tipo Ivor-Lewis robótica

Robotic Ivor-Lewis esophagectomy

Javier Martínez Caballero*, Cristina Alegre Torrado*, Pilar Gómez Rodríguez*, Elías Rodríguez Cuéllar*

* H. Universitario 12 de Octubre. Cirugía esofagogástrica y bariátrica.

DOI: https://doi.org/10.14679/5172

Resumen:

La esofagectomía tipo Ivor-Lewis realizada con la plataforma robótica combina los beneficios de la cirugía mínimamente invasiva con mayor precisión técnica, siendo especialmente útil en el tiempo torácico para la linfadenectomía y la anastomosis intratorácica.
La plataforma robótica supone una ventaja técnica sustancial gracias a la visión tridimensional inmersiva, la articulación de los instrumentos con siete grados de libertad, la filtración del temblor y la mayor maniobrabilidad en espacios reducidos. El tiempo torácico se realiza en decúbito prono con capnotórax (CO2), sin intubación selectiva. Este tiempo se beneficia especialmente de la plataforma robótica, que facilita la disección esofágica, la linfadenectomía y, particularmente, la realización de la anastomosis.
En este trabajo se muestra la realización de una anastomosis latero-lateral mecánica con sutura manual del defecto. Datos del registro internacional UGIRA muestran que la anastomosis lineal mecánica presenta las tasas más bajas de fuga en el abordaje Ivor-Lewis (15%), frente a la circular (17%) y la manual (33%).
La tasa de dehiscencia anastomótica considerada aceptable en centros de alto volumen se sitúa entre el 10-15%. En el registro UGIRA, la esofagectomía robótica ha disminuido la tasa de dehiscencia de anastomosis del 22% (2016-2018) al 16% (2021-2023), alcanzando el 15% en centros que superaron la curva de aprendizaje.
La esofagectomía robótica requiere una curva de aprendizaje entre 20 y 55 casos y conlleva mayor tiempo operatorio. La implementación mediante programas de formación estructurados permite alcanzar la competencia de forma segura.
Palabras Clave: Esofagectomía tipo Ivor-Lewis, plataforma robótica, cirugía mínimamente invasiva, videocirugía.

Abstract:

The Ivor Lewis esophagectomy performed using a robotic platform combines the benefits of minimally invasive surgery with greater technical precision, making it particularly useful during the thoracic phase for lymphadenectomy and intrathoracic anastomosis.
The robotic platform offers a substantial technical advantage thanks to immersive three-dimensional visualization, instrument articulation with seven degrees of freedom, tremor filtration, and enhanced maneuverability in confined spaces. The thoracic phase is performed in the prone position with capnothorax (CO₂), without selective intubation. This phase particularly benefits from the robotic platform, which facilitates esophageal dissection, lymphadenectomy, and especially the creation of the anastomosis.
This study demonstrates the performance of a side-to-side mechanical anastomosis with manual closure of the defect. Data from the international UGIRA registry show that linear mechanical anastomosis has the lowest leak rates in the Ivor Lewis approach (15%), compared with circular anastomosis (17%) and hand-sewn anastomosis (33%).
The anastomotic leak rate considered acceptable in high-volume centers ranges between 10% and 15%. In the UGIRA registry, robotic esophagectomy reduced the anastomotic leak rate from 22% (2016–2018) to 16% (2021–2023), reaching 15% in centers that had surpassed the learning curve.
Robotic esophagectomy requires a learning curve of approximately 20 to 55 cases and involves longer operative times. Implementation through structured training programs allows surgeons to achieve competency safely.

Key words: Ivor Lewis esophagectomy, robotic platform, minimally invasive surgery, videosurgery.

Bibliografía

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