ROBOT-ASSISTED THORACOSCOPIC SURGERY IN A NINE YEARS OLD PEDIATRIC PATIENT WITH A CYSTIC FORM OF DUPLICATION OF THE ESOPHAGUS

Purpose of this research was to share the Russia’s first clinical experience in the use of robot for thoracoscopic removal of cystic esophageal duplication and to explore whether robot could be involved in further thoracic esophageal surgeries. Authors represent a report of a clinical case of robot-assisted surgical treatment of a cystic tumor of the esophagus in a patient aged 9 y/o using the Versius Surgical Robot. The procedure was performed using three robotic modules – optical (10 mm, 3D visualization) and the two instrumental (5 mm each). An additional 5 mm port was used to deliver suture material and non-robotic instruments. Two-lung traditional ventilation was used during the surgical intervention. Aspiration of the cyst before final resection facilitated thoracoscopic visualization and removal of the specimen without the need for a mini-thoracotomy. The surgical intervention consisted of a longitudinal dissection of the muscular layer of the esophagus and enucleation of the cystic formation followed by covering of the muscular defect of the esophagus in order to ensure the integrity of its lumen. The total intervention duration was 155 minutes, of which the duration of robot installation (docking time) was 15 minutes and the duration of the main stage of the procedure was 140 minutes. No intraoperative or postoperative complications were recorded. Histological examination demonstrated the signs of the cystic form of duplication of the esophagus with the presence of ectopic gastric mucosa in its structure. The patient stayed in the hospital for seven days; there was no relapse of the disease observed during the entire observation period and therefore no repeated interventions were required. The subsequent control fibroesophagogastroscopy demonstrated a smooth profile of the esophageal mucosa without signs of a tumor mass. Conclusion: The use of robot-assisted thoracoscopic surgical access is a safe and effective method for treating cystic duplication of the thoracic esophagus.