P1.252. Robotic assisted management of Intraoperative Injury to an Anomalous retroportal Right Hepatic Artery During Radical Lymphadenectomy in Robotic Assisted Ivor Lewis Esophagectomy (RAMIE)

Abstract

Abstract Topic Esophageal Cancer: Trauma Case Title Introduction Radical lymphadenectomy during Ivor Lewis esophagectomy is technically demanding due to complex vascular anatomy and close proximity to major vessels. The presence of anomalous hepatic arterial anatomy further increases the risk of vascular injury, which can result in potentially catastrophic complications. Robotic platforms, with enhanced dexterity and three-dimensional visualization, may facilitate safe management of such unexpected intraoperative events. Case Details We report a video demonstration of a challenging case of locally advanced gastro-esophageal junction adenocarcinoma post 4 cycles of perioperative FLOT based chemotherapy was planned for robotic assisted Ivor Lewis esophagectomy with D2 lymphadenectomy. During suprapancreatic nodal dissection, an anomalous retroportal right hepatic artery was inadvertently injured. The vascular injury was promptly recognized intraoperatively. Robotic assistance enabled precise vascular exposure and control. The injured artery was carefully dissected, secured proximally and distally, and successfully repaired using intracorporeal suturing. Adequate hemostasis was achieved, and hepatic perfusion was confirmed intraoperatively. The proposed procedure was completed robotically without the need for conversion to open surgery. Results The postoperative course was uneventful, with no evidence of hepatic ischemia or biliary complications. Liver function tests remained within normal limits. Final histopathology demonstrated an adequate D2 lymph node yield with oncologically sound resection margins. Conclusion This case underscores the importance of preoperative awareness and intraoperative vigilance for vascular anomalies during D2 lymphadenectomy. It also demonstrates that robotic assistance can enable safe identification and repair of major vascular injuries, even in complex upper gastrointestinal oncologic procedures, while preserving oncological principles.