Novel Technique for Reduced Incision Laparoscopic Nissen Fundoplication Using a Single Incision Multiport Access Device with Flexible Instrumentation

John G Linn, MD, Kyle A Perry, MD, W. Scott Melvin, MD. The Ohio State University Medical Center

INTRODUCTION: Reduced incision surgery has generated significant interest in recent years. Few reports of reduced incision gastroesophageal fundoplication have been described. We report our initial case of a novel technique for reduced incision laparoscopic fundoplication using a single port device that accommodates multiple flexible instruments.

TECHNIQUE: A 55 year old man with longstanding history of gastroesophageal reflux was consented for reduced incision Nissen fundoplication. After induction of anesthesia, the Spider Surgical System (Transenterix, Morrisville NC) was introduced through an upper midline open trocar placement. A needlescopic grasper was used to elevate the left lateral segment of the liver. Flexible dissecting instruments and hook cautery were introduced through the Spider arms and used to dissect the esophageal hiatus. The short gastric vessels were divided with ultrasonic energy through a separate 5 mm trocar. The crura were reapproximated with interrupted permanent suture. A floppy, 360 degree fundoplication was created around the distal esophagus with permanent suture. All suturing was performed with flexible needle drivers via the Spider device. The device was removed, and the abdomen closed.

RESULT: Operative time was 209 minutes. The patient tolerated a liquid diet and was discharged on postoperative day 1. There were no adverse events. Quality of life and symptom severity indices were improved at 6 week follow up.

CONCLUSION: Reduced incision laparoscopic Nissen fundoplication is facilitated by use of a multichannel, single port access device with flexible instruments.