Robot-assisted laparoscopic Nissen fundoplication using the DaVinci Xi

Abstract

: Anti-reflux surgery remains an important option for treatment of gastroesophageal reflux disease (GERD). Approaches include transthoracic and transabdominal techniques, both open and minimally invasive. Transthoracic approaches are uncommonly performed, generally being limited to use in patients with a hostile abdomen. Transabdominal 360-degree posterior wrap, or Nissen fundoplication, is the most commonly performed anti-reflux operation worldwide. The use of the Da Vinci Xi surgical robot (Intuitive Surgical, Sunnyvale, CA, USA) adds some distinct advantages to the laparoscopic approach. These include: (I) a steady camera with high-definition, stereotactic view, (II) tremor reduction through the robotic console, (III) wristed instruments providing flexibility in angle of approach and dexterity, and (IV) bi-polar energy use for more delicate, precise tissue division without excessive thermal spread. The advantage of bi-polar energy delivery over monopolar cautery cannot be overstated. We describe our approach to DaVinci Xi Robot-assisted laparoscopic Nissen fundoplication.