Robotic Harvest of the Free Ileocolon Flap for Esophageal Reconstruction: A Case Report

Abstract

The ileocolon flap is a fully autologous, single-stage option in the reconstruction of challenging laryngoesophageal defects, restoring voice and swallowing in patients. This procedure represents one of the most sophisticated cases in the field of reconstructive microsurgery. However, the traditional approach to harvesting the ileocolon flap requires a midline laparotomy, which is associated with several donor site complications. In the literature, a minimally invasive approach for the harvest of this flap, which is complex, associated with numerous morbidities related to laparotomy, and has many modifications to perfect its outcomes, has not yet been defined. The purpose of this report is to describe the technique of robotic harvest of the free ileocolon flap to avoid the risks associated with laparotomy. A 53-year-old patient who underwent laryngectomy and cervical esophagectomy (15-cm defect) for treatment of laryngeal squamous cell carcinoma has been admitted to our department for restoration of voice and swallowing. The robotic surgery system (Da Vinci Xi, Intuitive Surgical) enables precise dissection of the ileum, colon, and ileocolic artery and vein by providing optimized high-definition visualization of the surgical field and enhanced control through robotic arms, which offer a much greater range of motion than the surgeon's hand or laparoscopic systems. The flap included 15 cm of ascending colon, ileocecal valve, 10 cm ileum (voice tube), and 5 cm of chimeric ileal segment (seromuscular patch flap). The flap insetted in the neck in an isoperistaltic fashion; ascending colon end-to-end to the esophageal stumps and voice tube anastomosed to tracheal stump in end-to-side fashion. The microvascular anastomoses were performed to the facial artery and external jugular vein. During a 4-month follow-up period, no complications were observed. The patient can eat solid food and speak with his own voice postoperatively. We believe that robotic harvesting of the free ileocolon flap is a safe, feasible, and effective technique that significantly reduces the risk of morbidity related to the invasiveness of the traditional flap harvesting technique.