Background: This study evaluated the feasibility of using robotic assistance for foregut surgery. It described the experience, advantages, and disadvantages of using the da Vinci system on the basis of 61 consecutive foregut cases by a minimally invasive, fellowship-trained surgeon. Methods: Data were collected on 61 consecutive foregut operations performed with the da Vinci system from July 2003 to Sept 2007. Data analyzed (SPSS for Windows) included surgery performed, indications for surgery, gender, age, BMI, EBL, port setup time, robot operating time, total case time, length of stay, complications, and resident involvement. Results: There were 38 Nissen fundoplications, 12 esophagomyotomies, and 11 paraesophageal hernia repairs for a correspondingly equal number of patients presenting with GERD, achalasia, and paraesophageal hernias. Four of the Nissen fundoplications had a gastropexy and three required a Collis gastroplasty. The Collis gastroplasty portion of the case was performed laparoscopically. Eight of the esophagomyotomies had a Toupet fundoplication and one had a paraesophageal hernia repair. Seven of the paraesophageal hernia repairs had a gastropexy and one had a Toupet fundoplication. There were 17 males and 44 females with an age of 55.2 ± 16.3 (range 18-85) years and a BMI of 27.8 ± 5.2 (15.4-46.8) kg/m². Times for the procedures in minutes were: Port setup time 29.1 ± 9.3 (14-63); Robot time 109.0 ± 36.5 (53-213); Total case time 167.8 ± 44.5 (102-281). The EBL was 28.7 ± 24.3 (5-100) ml. The length of stay was 1.8 ± 2.1 (1-14) days. Robot operating time averaged 66% of the case. Robot port setup time and robot operating time together comprised 82% of the case. Residents participated in 75% of the cases. There were no robot specific complications. The most significant advantage of the da Vinci system for foregut surgery was the visualization for an esophagomyotomy. Conclusions: These 61 consecutive cases demonstrated the technical feasibility of using the da Vinci system for performing foregut operations. Residents had an active part in most of the operations. The longevity of the DaVinci system’s use for foregut operations will be determined by comparing its cost and outcomes with that of conventional laparoscopic approaches. These questions are currently under study.
Program Number: P389