2024 World Conference on Lung Cancer (WCLC) - Posters-P2.14A.07 Learning Curve Analysis of Near-Infrared Fluorescence-Guided Robotic-Assisted Minimally Invasive Esophagectomy with Indocyanine Green Dye

P2.14A.07 Learning Curve Analysis of Near-Infrared Fluorescence-Guided Robotic-Assisted Minimally Invasive Esophagectomy with Indocyanine Green Dye

Back to course

Pdf Summary

This study explores the learning curve for a novel surgical technique called Near-Infrared Fluorescence-Guided Robotic-Assisted Minimally Invasive Esophagectomy (RAMIE), which utilizes indocyanine green (ICG) dye to enhance perfusion visualization during the procedure. This technique is used for esophageal cancer patients as a less invasive alternative to traditional open transthoracic esophagectomy, which is associated with high morbidity and prolonged recovery. RAMIE offers superior dexterity, enhanced visualization with 3D imaging, and a minimally invasive nature.<br /><br />The researchers sought to determine how many cases are required for a surgeon to reach technical proficiency in performing this procedure at the first Canadian center using this approach. The study enrolled 25 participants, of whom 23 completed the procedure. Two cases were withdrawn due to unforeseen complications, including hemodynamic instability and intra-abdominal adhesions requiring conversion to open laparotomy.<br /><br />The technique involved a two-stage surgical approach (abdominal and thoracic) with intravenous ICG injection, allowing enhanced visualization of the blood vessels and perfusion validation of surgical sites via near-infrared imaging. Patient demographics showed a median age of 68 years, predominantly male, with a median body mass index of 25.83 kg/m². The team's analysis employed cumulative sum (CUSUM) as a statistical method to track operative time and determine the learning curve, but no clear proficiency point was identified for the 23 cases analyzed.<br /><br />Clinical outcomes revealed no conversions to open surgery, a mean procedure time of approximately 378 minutes, minimal blood loss, and a median hospital stay of 8 days. Complications occurred in about 17% of patients, including hemorrhagic shock, tracheoesophageal fistula, and anastomotic leak. Overall, while ICG was successfully used in all cases, the proficiency target was not yet achieved, indicating the need for further procedural experience.

Asset Subtitle

Yogita S. Patel

Meta Tag

Speaker Yogita S. Patel

Topic Mesothelioma, Thymoma & Other Thoracic Tumors

Keywords

Near-Infrared Fluorescence-Guided

Robotic-Assisted Minimally Invasive Esophagectomy

RAMIE

Indocyanine Green

Esophageal Cancer

Learning Curve

Technical Proficiency

Cumulative Sum Analysis

Surgical Complications

Minimally Invasive Surgery