Evaluation of telesurgical (robotic) NISSEN fundoplication

Abstract

The telesurgical approach is feasible in advanced laparoscopic procedures like Nissen fundoplication. At the present time there is however no obvious added benefit from this new technique.

Robotic Foregut Surgery: One Surgeon’s Experience with Nissen Fundoplication, Esophagomyotomy, and Hiatal Hernia Repair

“…The published literature reports a perioperative complication average of 7.3% (0 -24) for robotic Nissen fundoplication patients [4][5][6][7][8][9][10][11][12][13], 6.4% (3 -13) for esophagomyotomy patients [16][17][18][19], and 15% (0 -31) for hiatal hernia repair patients [19][20][21]. Our series had similar results with 7% of Nissen fundoplication patients, 15% of esophagomyotomy patients, and 11% of hiatal hernia repair patients experiencing perioperative complications.…”

“…The mean TCT in the robotic Nissen fundoplication literature ranges from 65 -207 minutes [4][5][6][7][8][9][10][11][12][13]. Our mean TCT was 173 minutes, which is within that range but on the higher end.…”

“…The published literature reports a conversion rate average of 2.9% (0 -9) for Nissen fundoplication patients [4][5][6][7][8][9][10][11][12][13], 3.4% (0 -12.5) for esophagomyotomy patients [16,17,19], and 6.6% (0 -10.5) for hiatal hernia repair patients [19][20][21]. Of these, all of the Nissen fundoplication conversions were to laparoscopy, while all of the hiatal hernia conversions were to laparotomy.…”

“…This was attributed to a highly experienced robotic surgeon and a very specialized, experienced, and consistent surgical team. Cadiere et al [13] reported 10 cases with a mean TCT of 76 minutes. In this study the mobilization of greater curvature of the stomach was done laparoscopically and not robotically.…”

“…(1 -7.2) days for robotic Nissen fundoplication patients [4][5][6][7][8][9][10][11][12][13], 2.4 (1.5 -4) days for esophagomyotomy patients [8,[14][15][16][17][18], and 5 days for hiatal hernia repair patients [19][20][21]. Our series had a shorter LOS for all groups with a mean LOS of 1.7 days for all three procedures combined, 1.7 days for the Nissen fundoplication group, 1.2 days for the esophagomyotomy group, and 2.3 days for the hiatal hernia repair group.…”