Abstract
Purpose: The purpose of the study was to review a single surgeon, seven-year experience, using the Da Vinci Telerobotic system performing 124 foregut operations. Methods: Data review from 2002-2009 including 71 Nissen fundoplications, 26 esophagomyotomies, and 27 hiatal hernia repairs was performed. Parameters collected included gender, age, body mass index (BMI), estimated blood loss (EBL), port set up time (PST), robot operating time (ROT), total case time (TCT), length of stay (LOS), complications, conversions, and resident involvement. Statistical analysis was con-ducted. Results: 124 foregut operations: 45 males, 79 females, mean age of 54.8 ± 16.7 (18 - 85) years, mean TCT 174.4 ± 45.0 (102 - 321) min. Nissen fundoplication: mean BMI of 30.8 ± 3.9 (22.4 - 46.8) kg/m2, EBL 30.2 ± 21.8 (5 - 100) ml, PST 32.3 ± 9 (14 - 63) min, ROT 111.4 ± 37.3 (51 - 229) min, TCT 175.0 ± 46.4 (102 - 321) min, median LOS 1 (0 - 9) day, complication rate 7.0% (5/71), conversion rate 5.6%, resident involvement 69.0% (49/71). Esophagomyotomy: mean BMI of 26.5 ± 6.1 (15.4 - 36.6) kg/m2, EBL 39.1 ± 41.7 (10 - 200) ml, PST 28.0 ± 8.6 (16 - 47) min, ROT 122.9 ± 45 (31 - 217) min, and TCT 178.0 ± 40.5 (105 - 262) min, median LOS 1 (0 - 6) day, complication rate 15.4% (4/26), conversion rate 0%, resident involvement 69.2% (18/26). Hiatal hernia repair: mean BMI of 28.4 ± 4.2 (21.9 - 36.8) kg/m2, EBL 38.4 ± 32.7 (10 - 150) ml, PST 28.8 ± 8.0 (17 - 52) min, ROT 109.0 ± 44.5 (49 - 250) min, and TCT 169.2 ± 46.5 (102 - 299) min, median LOS 1 (1 - 14) day, complication rate 11.1% (3/27), conversion rate 3.7%, resident involvement 66.7% (18/27). Conclusion: Robotic-assisted foregut surgery is safe and effective. This series compares favorably with other robotic studies in length of hospital stay, total case time, and complication and conver-sion rates. Foregut surgery is an excellent robotic training ground for residents.
Highlights
Laparoscopic surgery for procedures such as Nissen fundoplication and esophagomyotomy are commonly performed
Robotic surgery has been shown to be a safe and effective alternative to laparoscopy with added benefits [1]
The objective of this study is to present data from our first 124 consecutive robotic foregut procedures, including Nissen fundoplications, esophagomyotomies, and hiatal hernia repairs and compare the results with those in the current robotic literature
Summary
Laparoscopic surgery for procedures such as Nissen fundoplication and esophagomyotomy are commonly performed. Robotic surgery has been shown to be a safe and effective alternative to laparoscopy with added benefits [1]. The Food and Drug Administration approved the da Vinci Robotic System® Intuitive Surgical Inc. Sunnyvale, CA for intra-abdominal surgery in 2000. This system provides instruments with articulated wrists to allow for seven degrees of motion, tremor filtration, comfortable ergonomics, up to ten fold magnification, and three-dimensional imaging. These benefits allow the surgeon to perform advanced procedures with greater precision and comfort. The first robotic Nissen fundoplication was reported in 1999 and was among the first procedures
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