fig4

Figure 4. Abdominal portion of robotic McKeown esophagectomy. Four robotic ports are placed, along with a liver retractor in the right upper quadrant and assistant port in the right lower quadrant [A: (c) camera port; (a) assistant port]; next, the greater omentum is divided after identifying the right gastroepiploic arcade (B, red arrow) and the dissection is carried up to the short gastric vessels (C); the stomach is rotated to the right and posterior attachments are divided (D); after ensuring circumferential dissection of the conduit, the mediastinal Penrose drain is delivered into the field (E); a 4-5 cm gastric conduit is created (E and F) and indocyanine green testing of the conduit is conducted prior to transecting the stomach (G); a transition stitch can be placed where there is a clear demarcation in perfusion (G insert); once the stomach is transected, two parallel lines are marked on the conduit to ensure that the conduit is pulled into the neck without torsion (H); a pyloric drainage procedure may be performed (I). The anastomosis is performed in the neck below the transition stitch (images not captured)