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

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DOI: 10.4236/ss.2012.31001    5,528 Downloads   8,578 Views   Citations

ABSTRACT

Purpose: The purpose of the study was to review a single surgeon, seven-year experience, using the Da Vinci Telerobotic system performing 124 foregut operations. Methods: Data review from 2002-2009 including 71 Nissen fundoplications, 26 esophagomyotomies, and 27 hiatal hernia repairs was performed. Parameters collected 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 was con-ducted. Results: 124 foregut operations: 45 males, 79 females, mean age of 54.8 ± 16.7 (18 - 85) years, mean TCT 174.4 ± 45.0 (102 - 321) min. Nissen fundoplication: 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, TCT 175.0 ± 46.4 (102 - 321) min, median LOS 1 (0 - 9) day, complication rate 7.0% (5/71), conversion rate 5.6%, resident involvement 69.0% (49/71). Esophagomyotomy: mean BMI of 26.5 ± 6.1 (15.4 - 36.6) kg/m2, EBL 39.1 ± 41.7 (10 - 200) ml, PST 28.0 ± 8.6 (16 - 47) min, ROT 122.9 ± 45 (31 - 217) min, and TCT 178.0 ± 40.5 (105 - 262) min, median LOS 1 (0 - 6) day, complication rate 15.4% (4/26), conversion rate 0%, resident involvement 69.2% (18/26). Hiatal hernia repair: 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, median LOS 1 (1 - 14) day, complication rate 11.1% (3/27), conversion rate 3.7%, resident involvement 66.7% (18/27). 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 complication and conver-sion rates. Foregut surgery is an excellent robotic training ground for residents.

Conflicts of Interest

The authors declare no conflicts of interest.

Cite this paper

F. Huettner, R. Alley, J. Doubet, M. Ryan, D. Dynda and D. Crawford, "Robotic Foregut Surgery: One Surgeon’s Experience with Nissen Fundoplication, Esophagomyotomy, and Hiatal Hernia Repair," Surgical Science, Vol. 3 No. 1, 2012, pp. 1-9. doi: 10.4236/ss.2012.31001.

References

[1] S. Horgan and D. Vanuno, “Technical Report Robots in Laparoscopic Surgery,” Journal of Laparoendoscopic & Advanced Surgical Techniques, Vol. 11, No. 6, 2001, pp. 415-419. doi:10.1089/10926420152761950
[2] G. B. Cadiere, J. Himpens, M. Vertruyen, J. Bruyns and G. Fourtanier, “Nissen Fundoplication Done by Remotely Controlled Robotic Technique,” Annales de Chirurgie, Vol. 53, No. 2, 1999, pp. 137-141.
[3] W. S. Melvin, K. R. Krause, B. J. Needleman, R. K. Wolf, R. E. Michler and E. C. Ellison, “Computer Assisted ‘Robotic’ Heller Myotomy: Initial Case Report,” Journal of Laparoendoscopic & Advanced Surgical Techniques, Vol. 11, No. 4, 2001, pp. 251-253. doi:10.1089/109264201750539790
[4] J. Hartmann, C. Menenakos, J. Ordemann, W. Raue and C. Braumann, “Long-Term Results of Quality of Life after Standard Laparoscopic vs Robot-Assisted Laparoscopic Fundoplications for Gastro-Oesophageal Reflux Disease. A Comparative Trial,” International Journal of Medical Robotics and Computer Assisted Surgery, Vol. 5, No. 1, 2009, pp. 32-37. doi:10.1002/rcs.228
[5] J. Hartmann, C. A. Jacobi, C. Menenakos, M. Ismail and C. Braumann, “Surgical Treatment of Gastroesophageal Reflux Disease and Upsidedown Stomach Using the da Vinci Robotic System. A Prospective Study,” Journal of Gastrointestinal Surgery, Vol. 12, No. 3, 2008, pp. 504-509. doi:10.1007/s11605-007-0400-z
[6] J. Heemskerk, W. G. Van Gemert, J. W. Greve and N. D. Bouvey, “Robot-Assisted versus Conventional Laparoscopic Nissen Fundoplication: A Comparative Retrospective Study on Costs and Time Consumption,” Surgical Laparoscopy Endoscopy Percutaneous Techniques, Vol. 17, No. 1, 2007, pp. 1-4. doi:10.1097/01.sle.0000213756.76761.b7
[7] M. Morino, L. Pellegrino, C. Giaccone and F. Rebecchi, “Randomized Clinical Trial of Robot-Assisted versus Laparoscopic Nissen Fundoplication,” British Journal of Surgery, Vol. 93, No. 5, 2006, pp. 553-558. doi:10.1002/bjs.5325
[8] E. L. Nakadi, C. Melot, J. Closset, V. DeMoor, K. Betroune, P. Feron, P. Lingier and M. Gelin, “Evaluation of da Vinci Nissen Fundoplication Clinical Results and Cost Minimization,” World Journal of Surgery, Vol. 30, No. 6, 2006, pp. 1050-1054. doi:10.1007/s00268-005-7950-6
[9] B. P. Muller-Stich, M. A. Reiter, M. N. Wente, V. V. Bintintan, J. Koninger, M. W. Buchler and C. N. Gutt, “Robot-Assisted versus Conventional Laparoscopic Fundoplication: Short-Term Outcome of a Pilot Randomized Controlled Trial,” Surgical Endoscopy, Vol. 21, No. 10, 2007, pp. 1800-1805. doi:10.1007/s00464-007-9268-y
[10] W. A. Draaisma, J. P. Ruurda, C. H. Schefer, R. K. J. Simmermacher, H. G. Gooszen, H. G. Rijnhart-De Jong, E. Buskens and I. A. M. J. Broeders, “Randomized Clinical Trial of Standard Laparoscopic versus Robot-Assisted Laparoscopic Nissen Fundoplication for Gastro-Oeso- phageal Reflux Disease,” British Journal of Surgery, Vol. 93, No. 11, 2006, pp. 1351-1359. doi:10.1002/bjs.5535
[11] M. Talamini, K. Campbell and C. Stanfield, “Robotic Gastrointestinal Surgery: Early Experience and System Description,” Journal of Laparoendoscopic & Advanced Surgical Techniques, Vol. 12, No. 4, 2002, pp. 225-232. doi:10.1089/109264202760267970
[12] W. S. Melvin, B. J. Needleman, K. R. Krause, C. Schneider and E. C. Ellison, “Computer-Enhanced vs Standard Laparoscopic Antireflux Surgery,” Journal of Gastrointestinal Surgery, Vol. 6, No. 1, 2002, pp.11-16. doi:10.1016/S1091-255X(01)00032-4
[13] G. B. Cadiere, J. Himpens, M. Vertruyen, J. Bruyns, O. Germay, G. Leman and R. Izizaw, “Evaluation of Telesurgical (Robotic) Nissen Fundoplication,” Surgical Endoscopy, Vol. 15, No. 9, 2001, pp. 918-923. doi:10.1007/s004640000217
[14] L. C. Huffmann P. K. Pandalai, B. J. Boulton, L. James, S. L. Starnes, M. F. Reed, J. A. Howington and M. S. Nussbaum, “Robotic Heller Myotomy: A Safe Operation with Higher Postoperative Quality-of-Life Indices,” Surgery, Vol. 142, No. 4, 2007, pp. 613-620. doi:10.1016/j.surg.2007.08.003
[15] A. Iqbal, M. Haider, K. Desai, N. Garg, J. Kavan, S. Mittal and C. J. Filipi, “Technique and Follow-Up of Minimally Invasive Heller Myotomy for Achalasia,” Surg Endosc, Vol. 20, 2006, pp. 394-401. doi:10.1007/s00464-005-0069-x
[16] C. Galvani, M. V. Gorodner, F. Moser, M. Baptista, P. Donahue and S. Horgan, “Laparoscopic Heller Myotomy for Achalasia Facilitated by Robotic Assistance,” Surgical Endoscopy, Vol. 20, No. 7, 2006, pp. 1105-1112. doi:10.1007/s00464-005-0272-9
[17] W. S. Melvin, J. M. Dundon, M. Talamini and S. Horgan, “Computer-Enhanced Robotic Telesurgery Minimizes Esophageal Perforation during Heller Myotomy,” Surgery, Vol. 138, No. 4, 2005, pp. 553-559. doi:10.1016/j.surg.2005.07.025
[18] S. Horgan, C. Galvani, M. V. Gorodner, P. Omelanczuck, F. Elli, F. Moser, L. Durand, M. Carcoche, J. Nefa, S. Bustos, P. Donahue and P. Ferraina, “Robotic-Assisted Heller Myotomy versus Laparoscopic Heller Myotomy for the Treatment of Esophageal Achalasia: Multicenter Study,” Journal of Gastrointestinal Surgery, Vol. 9, No. 8, 2005, pp. 1020-1030. doi:10.1016/j.gassur.2005.06.026
[19] J. P. Ruurda, W. A. Draaisma, R. van Hillegersberg, I. H. M. B. Rinkes, H. G. Gooszen, L. W. M. Janssen, R. K. J. Simmermacher and I. A. M. J. Broeders, “Robot-Assisted Endoscopic Surgery: A Four-Year Single-Center Experience,” Digestive Surgery, Vol. 22, No. 5, 2005, pp. 313-320. doi:10.1159/000088628
[20] C. Braumann, C. A. Jacobi, C. Menenakos, M. Ismail, J. C. Rueckert and J. M. Mueller, “Robotic-Assisted Laparoscopic and Thoracoscopic Surgery with the da Vinci: A 4-Year Experience in a Single Institution,” Surgical Laparoscopy Endoscopy Percutaneous Techniques, Vol. 18, No. 3, 2008, pp. 260-266. doi:10.1097/SLE.0b013e31816f85e5
[21] W. A. Draaisma, H. G. Gooszen and I. A. M. J. Broeders, “Mid-Term Results of Robot-Assisted Laparoscopic Repair of Large Hiatal Hernias: A Symptomatic and Radiologic Follow-Study,” Surgical Laparoscopy Endoscopy Percutaneous Techniques, Vol. 16, No. 4, 2006, p. 300. doi:10.1097/00129689-200608000-00070

  
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