221 Reducing the Learning Curve from Minimally Invasive Oesophagectomy (MIO) to Robot-Assisted Minimally Invasive Oesophagectomy (RAMIO). A Single Centre Experience of Outcomes Using the Same Anastomotic Technique

Abstract Aim There is a significant learning curve associated with performing robot-assisted minimally invasive oesophagectomy (RAMIO). The aim of this study was to demonstrate comparable outcomes when using the same, reproducible anastomotic technique as minimally invasive oesophagectomy (MIO). Method This study included fifty consecutive MIO and RAMIO cases performed between October 2022 and February 2025 by one surgeon, in a single tertiary centre. Data was collected retrospectively. The same end to side anastomotic technique (Medtronic DST Series EEA OrVil) was used for all cases. Demographic, surgical, and oncological outcomes were assessed. Data was analysed in excel using SPSS version 30. Results There was no significant difference in patient demographics between RAMIO and MIO groups. Median operative time was 381 minutes (RAMIO IQR 353- 409) and 282 minutes (MIO IQR 250-351) p=0.002. Median length of stay was 12 days (RAMIO IQR 10-14) and 10 days (MIO IQR 9-13) (p=0.047). There was no difference in post-operative complication rate: anastomotic leak rate (RAMIO 2%, MIO 6% p=0.617), staple line leak (RAMIO 0%, MIO 2% p=1), chyle leak (RAMIO 2%, MIO 0% p=1), and pneumonia (RAMIO 32%, MIO 22% p=0.3). RAMIO had a higher rate of R0 resections, clear circumferential margins and lymph node yield (R0 RAMIO 83.7%, MIO 76% p=0.34, clear circumferential margins RAMIO 83.7%, MIO 76% p=0.34, median lymph node RAMIO 29 IQR 22-36, MIO 28.5 IQR 23-33.75 p .63). Conclusions These comparable outcomes demonstrate that using a reproducible anastomotic technique can help to reduce the learning curve when transitioning from MIO to RAMIO.