Robot Assisted Esophagectomy
Guidelines for the management of oesophageal and gastric cancer. Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland, the British Society of Gastroenterology and the British Association of Surgical Oncology.
Step by step
Thoracic cavity approach
Before the introduction of the trocars, the right lung is desufflated. First, a 12 mm trocar for robot camera is placed in the 6th intercostal space, 3 cm dorsally to the axillary line. Two 12 mm trocars are inserted in the 4th and the 9th intercostal space in the axillary line. Two robotic 8 mm trocars are positioned; one in the 5th intercostal space, just ventral to the scapula and one in the 8th intercostal space at the level of the inferior angle of the scapula.
Intercostal vessels injury
The important intercostal vessels lie directly on the caudal side of the rib, and if punctured can cause serious hemorrhage.
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