Robotic Approach to Giant Paraesophageal Hernia Repair
Presented by Ankit D Patel, MD at the SAGES 2014 Meeting; Panel – Concurrent Session SS12 Robotics/Ergonomics
Juan P Toro, MD, Hernan D Urrego, MD, Aliu O Sanni, MD, John F Sweeney, MD, S. Scott Davis Jr., MD, Edward Lin, DO, MBA, Ankit D Patel, MD; Department of Surgery, Emory University. Atlanta, GA
Points of interest:
case summary–32 sec
OR setup–47 sec
port placement/instruments–1:45
procedure begins–2:04
hernia reduction–2:10
dissection of hernia sac–2:24
hiatus mobilization–3:00
Keyword(s): 0 Silk interrupted stitches, 12 mm trocars, 3D visualization, 4 arm da Vinci Si robot, 8 mm trocars DV, ABD, additional suture, adequate intrabdominal esophageal length, advanced bipolar device, advantages, anesthesia, anterior closure, anterior stitches, aorta, arm #2, arm #3, articulation, assess mucosal integrity, assistant, avoid expense, binocular tridimensional visualization, BioA bioabsorbable pledgets, bipolar cutting device, bipolar device, bottom anterior stitch, cadiere grasper, calibration Bougie, chest CT scan, chronic cough, completely divided, console, create, diagram, dissection of hernia sac, distal esophagus, double fenestrated grasper, easy passage of the endoscope, Emory endosurgery, encircle, epiploic attachments, esophagus, evidence of ineffective esophageal motility, expose hiatus, failed medical management, frequent asthma exacerbations, fundoplication, GEJ, GEJ position, gentle blunt dissection, heartburn, hernia closure, hernia reduction, hiatus mobilization, identification of planes, instruments, intra-abdominal esophageal length, intraoperative endoscopy, intubated, laparoscopic scissors, laparoscopic set, laparosocpy, large PEH, laterally, left crus, liver, liver retractor, long term PPIs, mediastinal attachments, mediastinum, monitoring devices, needle drive, no complications, nontraumatic retraction, OR setup, OR table, paraesophageal hernia repair, patient-side cart, patients head, penrose drain, penrose drain retraction, percutaneous endoscopic gastrostomy, phrenoesophageal ligament, pleural cavity, pneumatic leak test, POD 2, port placement, port sites, position of defect, posterior closure, posteriorly, reduced stomach, reinforcement of suture line, retracted down, retroesophageal window, reverse Trendelenberg, right crus, risk of tearing, robot arms, robot docking, robotic approach, robotic instruments, robotic platform, robotic shears, round Blake drain, scrub tech, separated circumferentially, size of defect, slight right tilt, slipped knot technique, small surgical fields, stomach, supine, suspected DGE, suturing principles, tissue compression ratio, too constricting, tubing, utiliization, verify, Vessel sealer, vision cart, wider range of motion