Worldwide Techniques and Outcomes in Robot-assisted Minimally Invasive Esophagectomy (RAMIE): Results From the Multicenter International Registry

UGIRA Study Group, B Feike Kingma, Peter P Grimminger, Pieter C van der Sluis, Marc J van Det, Ewout A Kouwenhoven, Yin-Kai Chao, Chun-Yi Tsai, Hans F Fuchs, Christiane J Bruns, Inderpal S Sarkaria, James D Luketich, Jan W Haveman, Boudewijn van Etten, Philip W Chiu, Shannon M Chan, Philippe Rouanet, Anne Mourregot, Jens-Peter Hölzen, Rubens A SallumIvan Cecconello, Jan-Hendrik Egberts, Frank Benedix, Mark I van Berge Henegouwen, Suzanne S Gisbertz, Daniel Perez, Kristina Jansen, Michal Hubka, Donald E Low, Matthias Biebl, Johann Pratschke, Paul Turner, Kish Pursnani, Asif Chaudry, Myles Smith, Elena Mazza, Paolo Strignano, Jelle P Ruurda, Richard van Hillegersberg*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

41 Citations (Scopus)


OBJECTIVE: This international multicenter study by the Upper GI International Robotic Association aimed to gain insight in current techniques and outcomes of RAMIE worldwide.

BACKGROUND: Current evidence for RAMIE originates from single-center studies, which may not be generalizable to the international multicenter experience.

METHODS: Twenty centers from Europe, Asia, North-America, and South-America participated from 2016 to 2019. Main endpoints included the surgical techniques, clinical outcomes, and early oncological results of ramie.

RESULTS: A total of 856 patients undergoing transthoracic RAMIE were included. Robotic surgery was applied for both the thoracic and abdominal phase (45%), only the thoracic phase (49%), or only the abdominal phase (6%). In most cases, the mediastinal lymphadenectomy included the low paraesophageal nodes (n=815, 95%), subcarinal nodes (n = 774, 90%), and paratracheal nodes (n = 537, 63%). When paratracheal lymphadenectomy was performed during an Ivor Lewis or a McKeown RAMIE procedure, recurrent laryngeal nerve injury occurred in 3% and 11% of patients, respectively. Circular stapled (52%), hand-sewn (30%), and linear stapled (18%) anastomotic techniques were used. In Ivor Lewis RAMIE, robot-assisted hand-sewing showed the highest anastomotic leakage rate (33%), while lower rates were observed with circular stapling (17%) and linear stapling (15%). In McKeown RAMIE, a hand-sewn anastomotic technique showed the highest leakage rate (27%), followed by linear stapling (18%) and circular stapling (6%).

CONCLUSION: This study is the first to provide an overview of the current techniques and outcomes of transthoracic RAMIE worldwide. Although these results indicate high quality of the procedure, the optimal approach should be further defined.

Original languageEnglish
Pages (from-to)e386-e392
JournalAnnals of Surgery
Issue number5
Publication statusPublished - 1 Nov 2022

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