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This preclinical feasibility study investigates the potential of utilizing the hinotori™ robot system for esophagectomy. In three human cadaver models, the esophagus was successfully mobilized and resected using the hinotori™ system, with a mean thoracic procedure time of 57 minutes. The system allowed for precise dissection and radical lymphadenectomy without arm collision, attributed to its versatile design and docking-free trocars. Standard robot-specific patient positioning, including a 35° left lateral inclination, and trocar placement in a posterior axillary line configuration were employed. Notably, trocars suitable for both laparoscopy and the hinotori™ robot were utilized, providing flexibility in trocar selection. Unique features, such as the ergonomic console and pointer-based pivot point identification system, contributed to procedural success. While these findings highlight the promising potential of the hinotori™ system in advancing esophageal surgery, further clinical studies are warranted to validate its reproducibility and clinical utility. Additionally, enhancements to the pivot point identification system and evaluation of the arm base's features may further optimize surgical outcomes. [ABSTRACT FROM AUTHOR]

Minimally invasive Ivor-Lewis Esophagectomy (MIE) is widely accepted as a surgical treatment of resectable esophageal cancer. Aim of this paper is to describe the surgical details of our standardized MIE technique and its safety. We also evaluate the esophageal mobilization in semiprone compared to the left lateral position. A retrospective analysis of 141 consecutive patients who underwent Ivor-Lewis esophagectomy for cancer, from February 2016 to September 2021, was conducted. All the procedures were performed by totally thoraco-laparoscopic with an intrathoracic end-to-side circular stapled anastomosis. Thoracic phase was performed in left lateral position (LLP-group, n =47) followed by a semiprone position (SP-group, n =94). The intraoperative and postoperative outcomes were prospectively collected and analyzed. The procedure was completed without intraoperative complication in 94.68% of cases in SP-group and in 93.62% of cases in LLP-group (P =0.99). The total operative time and thoracic operative time were significantly shorter in SP-group (P =0.0096; P =0.009). No statistically significant differences were detected in postoperative outcomes between the groups, except for anastomotic strictures (higher in LLP-group, P =0.02) and intensive care unit stay (longer in LLP-group, P =00.1). No reoperation was needed in any cases. Surgical radicality was comparable; the median of harvested lymph nodes was significantly higher in SP-group (P <0.0001). The present semiprone technique of thoraco-laparoscopic Ivor-Lewis esophagectomy is safe and feasible but may also provide some advantages in terms of lymph nodes harvested and total operation time. [ABSTRACT FROM AUTHOR]

Background Electronic stimulation oft the lower esophageal sphincter (LES) is a new promising anti-reflux procedure that is established in Germany since 2014. Basically two leads are inserted laparoscopicaly into the LES and connected to an implantable pulse generator (IPG) which is placed in a subcutaneous pocket. This stimulation is supposed to build up the muscular anti-reflux barrier. It is limited to patients with a small hiatal hernia < 3 cm and reflux esophagitis LA Classification Type A-C. Although long-term results up to 4 years with a good postoperative reflux control and an increased quality of life have been published, no data about Endostim™ non-responders, difficult postoperative situations and procedure failure has been reported yet. Methods Between 12/2015 and 11/2017 12 patients underwent laparoscopy for an Endostim™ implantation. All patients had an upper endoscopy, a barium swallow, high-resolution esophageal impedance manomentry (HRIM), 24-hour multi-channel impedance and pH monitoring (MII-pH) prior to the procedure and after 6 months. The quality of life was assessed with the GERD health related quality of life (GERD-HRQL) questionnaire preoperatively and during further follow-up. Results 6 of 12 patients (50%), 2 female 4 male, reported new GERD symptoms after an initial postoperative symptom relief. 1 patient had a prolonged period (15 months) of reprogramming until complete symptom control was achieved. 1 patient had a recurrent 3 cm hiatal hernia after 3 months, so that only a partial responds was reported. In 2 patients reprogramming could not reach a proper responds. Two patients showed a complete technical failure due to a broken lead close to the IPG. Conclusion Reasons for Endostim™ failure can be heterogeneous. Because it is a young and new procedure non-responders should be investigated closely so that there can be a critical discussion about indications, contraindications and negative predictive factors. Disclosure All authors have declared no conflicts of interest. [ABSTRACT FROM AUTHOR]

Background Electric stimulation of the lower esophageal sphincter is a new surgical option for patients with gastroesophageal reflux disease (GERD) and a diaphragmatic hernia less than 3 cm. In comparison to standard anti-reflux procedures like Nissen or Toupet fundoplication the procedure's advantage is that there had been no report on postoperative dysphagia. Esophageal motility disorders can increase the risk of dysphagia after fundoplication. Therefor EndostimÔ might be an alternative for these patients. Methods Between December 2015 and November 2017 twelve patients with GERD received Endostim™ therapy. All patients underwent endoscopy, high resolution impedance manometry (HRIM), 24 hour impedance pH-monitoring and a barium swallow. Quality of life was assessed by GERD-HRLQ a validated questionnaire. Results Seven patients with an esophageal motility disorder received an Endostim™ due to symptomatic GERD. Three patients had an esophageal hypomotility, 2 patients had a CREST syndrome and 2 patients showed a functional outflow obstruction in HRIM. There were no postsurgical complications. No dysphagia, regurgitation or retrosternal pain was reported. After a follow up of 6 months all patients are satisfied with the procedure and report an increase of their quality of life. Conclusion These results demonstrate the feasibility of an Endostim™ therapy in patients with esophageal motility disorders for the first time. Disclosure All authors have declared no conflicts of interest. [ABSTRACT FROM AUTHOR]