Jiashou Xu, MD, Giovanni Begossi, MD, Gregory A Broderick-Villa, MD, Teresa Kim, Rupert Horoupian, Steve A Stanten, Ajay K Upadhyay. Alta Bates Medical Center
Introduction: Paraesophageal hernia repair (PHR) has seen a dramatic evolution with the introduction of laparoscopic surgery and its feasibility and clinical outcomes well demonstrated. The adoption rate of robotic-assisted PHR has not been as widely accepted. In analyzing the University Health data of 12,079 patients, robotic fundoplication repair made up 2.8% of all operations with open repair at 18% and laparoscopic at 79.2%. The same data demonstrated higher costs in open surgery due to increased length of stay and complications compared to robotic-assisted surgery. The purpose of our study is to share our experience with one of the largest retrospective series in robotic PHR in a non-university, minimally invasive surgery fellowship program. Furthermore, our training model is able to achieve excellent patient outcomes.
Methods: A retrospective chart review was performed of 135 large minimally invasive PHRs between January 1st 2008 – August 1st, 2016. The data was filtered for Da Vinci robot-assisted PHR. This data was then analyzed to assess the patient characteristics, surgical methodology, fellow participation, as well as outcomes.
Results: Out of a total of 135 cases utilizing a minimally invasive approach, 44 patients in our series underwent a robotic PHR. The hiatal hernia types: four (9.1%) type 2 , 36 (81.8%) type 3, and four (9.1%) type 4. The average age of patients was 67 years old and median American Society of Anesthesiologist (ASA) class of III. All cases were performed with robotic-assistance , however, one case required conversion to laparoscopy. Three patients were revisional cases and two patients had concomitant bariatric procedures. Twenty-seven patients (61.4%) had a Nissen fundoplication, 12 (27.2%) patients had a partial fundoplication, and five (11.4%) had no fundoplication. Six patients had mesh reinforcement. Fellows participated in 82.9% of robotic-assisted cases. The average length of stay was 3.1 days. Two (4.5%) patients suffered perioperative complications including reintubation and transfusion of one unit of blood. No mortalities were noted in our series.
Conclusion: The utilization rate of robotic-assisted surgery in foregut has been well described, but still under utilized compared to open surgery. Our series demonstrates the ability to achieve comparable outcomes to laparoscopic surgery utilizing robotic-assistance in a fellowship training environment. Further investigation into open to laparoscopic and robotic surgery learning curves could highlight described advantages to robotic surgery and advance patient surgical care.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 78974
Program Number: P695
Presentation Session: Poster (Non CME)
Presentation Type: Poster
