Basem G Soliman, MD, Duc T Nguyen, MD, PhD, Edward Y Chan, MD, Ray K Chihara, MD, PhD, Edward A Graviss, PhD, MPH, FIDSA, Leonora M Meisenbach, DNP, RN, ACNPBC, Min P Kim, MD, FACS. Houston Methodist Hospital
Introduction: We postulated that the use of robotics may significantly improve outcomes in hiatal hernia repair.
Methods and Procedures: We performed a retrospective analysis of prospectively collected STS database at a single institution of patients who underwent elective hiatal hernia repair from 2012 to 2017 using either laparoscopy or the da Vinci Xi robot. We compared patient characteristics and outcomes. Univariate and multivariate logistic regression modeling was performed to determine the factors associated with postoperative morbidity.
Results: There were 295 patients underwent elective hiatal hernia repair using either a laparoscopic (n=152) or robotic (n=143) technique. There was no significant difference in age, gender, BMI, smoking history, presence of co-morbidity nor hiatal hernia type. Seventy percent of the cases were a repair of either type III or type IV hiatal hernia. There were significantly higher ASA III and IV (7.9% vs 4.9%, p = 0.04) and lower redo-repair (8% vs 21%, p < 0.001) in the laparoscopic group compared to the robotic group. Hospital length of stay was significantly shorter (1.3 ± 1.8 vs 1.8 ± 1.5, p < 0.001) and there were significantly lower rates of complication (6.3 vs. 19.1 %, p = 0.002) after robotic compared to laparoscopic hiatal hernia repair. There was no difference in readmission rate and mortality. Multiple logistic regression analysis showed that age and laparoscopic technique were associated with complications after surgery.
Conclusion: Use of the da Vinci Xi robot in our institution significantly improves outcomes compared to laparoscopic hiatal hernia repair despite higher incidence of re-operative cases in the robotic group. This may be due to the improved visualization and articulation of instruments that the robot provides over a laparoscope during a complex hiatal hernia repair.
Table 1. Pateint Characteristics
Total n=295 | Lap n=152 | Robot n=143 | p-value | |
|---|---|---|---|---|
| ASA classification | 0.04 | |||
| II | 115(39) | 49(32.2) | 66(46.2) | |
| III | 161(54.6) | 91(59.9) | 70(49) | |
| IV | 19(6.4) | 12(7.9) | 7(4.9) | |
| Hernia Type | 0.14 | |||
| I | 87(29.5) | 37(24.3) | 50(35) | |
| III | 197(66.8) | 109(71.7) | 88(61.5) | |
| IV | 11(3.7) | 6(3.9) | 5(3.5) | |
| Reoperation | 42(14.2) | 12(7.9) | 30(21) | 0.001 |
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 92423
Program Number: P495
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster