Robotic Foregut Surgery: One Surgeon’s Experience with Nissen Fundopliction, Esophagomyotomy, and Hiatal Hernia Repair

Objective: To review the use of robotic assistance during foregut surgery including Nissen fundoplication, esophagomyotomy, and hiatal hernia repair. We evaluated a seven-year experience of one minimally invasive surgery fellowship-trained surgeon performing 124 foregut operations using the Da Vinci Telerobotic system. Surgical resident participation was tracked over this same period.

Methods: An IRB approved retrospective review of prospectively collected data from 2002 – 2009 of 71 Nissen fundoplications, 26 esophagomyotomies, and 27 hiatal hernia repairs was performed. Data collected for all three groups 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 using the Anova test was conducted.

Results: One-hundred and twenty-four robotic assisted foregut operations were performed on 45 males and 79 females with a mean age of 54.8 ± 16.7 (18-85) years. The mean TCT was 174.4 ± 45.0 (102-321) min.

Nissen fundoplication results included: 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, and TCT 175 ± 46.4 (102-321) min. The median LOS was 1 (0-9) day. The complication rate was 7.0% (5/71). Four cases were converted to laparoscopy, none to open, with a conversion rate of 5.6 %. Residents were involved in the Nissen fundoplication cases 69.0% (49/71) of the time.

Esophagomyotomy results included: mean BMI of 26.5 ± 6.1 (15.4-36.6) kg/m², EBL 39.1 ± 41.7 (10-200) ml, PST 28 ± 8.6 (16-47) min, ROT 122.9 ± 45 (31-217) min, and TCT 178 ± 40.5 (105-262) min. The median LOS was 1 (0-6) day. The complication rate was 15.4% (4/26) including 1 case of iatrogenic gastric perforation. No conversion to laparoscopy or laparotomy was needed. Residents were involved in the esophagomyotomies 69.2% (18/26) of the time.

Hiatal hernia repair results included: 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. The median LOS was 1 (1-14) day. The complication rate was 11.1% (3/27). One case was converted to laparoscopy, none to open, with a conversion rate of 3.7%. Residents were involved in the hiatal hernia repairs 66.7% (18/27) of the time.

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 rates of complication and conversion. Resident participation was significant and increased over the training period. Foregut surgery is an excellent robotic training ground for residents with its narrow operative field and diversity of skills required.


Session: Poster

Program Number: P557

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