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Iaquinandi F, Pini R, Sabbatini F, Toti JMA, Garofalo F, La Regina D, Mongelli F. Robotic-assisted treatment of paraesophageal hernias in the emergency setting: a retrospective study. J Robot Surg 2024; 18:228. [PMID: 38809354 DOI: 10.1007/s11701-024-01975-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 05/10/2024] [Indexed: 05/30/2024]
Abstract
Emergency treatment of paraesophageal hernias can be carried out through laparotomy or minimally invasive approaches, however, evidence in this regard is weak. The aim of our study was to assess safety and feasibility of the robotic-assisted treatment of paraesophageal hernias in the emergency setting. At the Bellinzona e Valli Regional Hospital, Switzerland, we conducted a retrospective analysis of patients operated on from January 2020 to January 2024 with robotic surgery for emergency presentation of paraesophageal hernias. Demographic and clinical details, operative techniques, and postoperative outcomes were collected and analyzed. Out of 82 patients who underwent robotic-assisted paraesophageal hernia repair, 17 were treated in the emergency setting. Median age was 79 years (IQR 77-85), 3 (17.6%) patients were male, and median BMI was 23.9 kg/m2 (IQR 21.0-26.0). Most frequent presentation symptoms were pain (100%), regurgitation (88.2%), and dyspnea (17.6%). No intraoperative complication, conversion to open surgery or stomach resections were recorded. Two complications of grade 3 according to the Clavien-Dindo classification and one of grade 2 occurred; all were successfully treated until resolution. The median length of hospital stay was 8 days (IQR 5-16). After a mean follow-up of 15.9 months (IQR 6.5-25.6) only two small axial asymptomatic recurrences that required no treatment. Despite limitations, our study demonstrated a very low rate of intra- and postoperative complications, likely supporting the safety and feasibility of robotic-assisted treatment for paraesophageal hernias in emergency settings. Larger studies with a control arm are needed to validate our initial findings.
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Affiliation(s)
- Fabiano Iaquinandi
- Department of Surgery, Ospedale Regionale di Bellinzona e Valli Regional Hospital, EOC, via Gallino 12, 6500, Bellinzona, Switzerland
| | - Ramon Pini
- Department of Surgery, Ospedale Regionale di Bellinzona e Valli Regional Hospital, EOC, via Gallino 12, 6500, Bellinzona, Switzerland
| | - Flaminia Sabbatini
- Department of Surgery, Ospedale Regionale di Bellinzona e Valli Regional Hospital, EOC, via Gallino 12, 6500, Bellinzona, Switzerland
| | - Johannes Maria Alberto Toti
- Department of Surgery, Ospedale Regionale di Bellinzona e Valli Regional Hospital, EOC, via Gallino 12, 6500, Bellinzona, Switzerland
| | - Fabio Garofalo
- Department of Surgery, Lugano Regional Hospital, EOC, via Tesserete 46, 6900, Lugano, Switzerland
| | - Davide La Regina
- Department of Surgery, Ospedale Regionale di Bellinzona e Valli Regional Hospital, EOC, via Gallino 12, 6500, Bellinzona, Switzerland
- Faculty of Biomedical Sciences, Università Della Svizzera Italiana, Via G. Buffi 13, 6900, Lugano, Switzerland
| | - Francesco Mongelli
- Department of Surgery, Ospedale Regionale di Bellinzona e Valli Regional Hospital, EOC, via Gallino 12, 6500, Bellinzona, Switzerland.
- Faculty of Biomedical Sciences, Università Della Svizzera Italiana, Via G. Buffi 13, 6900, Lugano, Switzerland.
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Odeh AM, Wyant K, Freeman RK, Abdelsattar ZM. Tackling complex thoracic surgical operations with robotic solutions: a narrative review. J Thorac Dis 2024; 16:1521-1536. [PMID: 38505049 PMCID: PMC10944716 DOI: 10.21037/jtd-23-1570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 12/15/2023] [Indexed: 03/21/2024]
Abstract
Background and Objective The adoption of robotic surgery for general thoracic surgery has rapidly progressed over the last two decades from its application in basic operations to complex pathologies. As such, the purpose of this narrative review is to highlight the collective experience of tackling complex thoracic surgical operations with minimally invasive robotic solutions. Methods Electronic searches of PubMed were conducted for each subtopic, using specific keywords and inclusion criteria. Once identified, the articles were screened through the abstract, introduction, results and conclusion for relevancy, and included based on a standard narrative review inclusion criteria. Key Content and Findings The role of the robotic approach has increased in thoracic outlet syndrome, chest wall resection, tracheobronchomalacia, airway and sleeve lung surgery, lobectomy after neoadjuvant therapy, complex segmentectomy, giant paraesophageal hernia repair, esophagectomy and esophageal enucleation, mediastinal masses and thymectomy and lung transplantation. Robotic surgery has several advantages when compared to video-assisted and open thoracoscopic surgery. These include better pain control and aesthetic outcome, improved handling of complex anatomy, enhanced access to lymph nodes, and faster recovery rates. Although it is associated with longer operative time, robotic surgery has comparable morbidity rates. Conclusions The robotic approach to complex thoracic problems is safe, effective, and associated with improved patient outcomes. To encourage wider adoption of robotic technology, increased training and expanded research efforts are essential, alongside improved worldwide access to this technology.
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Affiliation(s)
- Ayham M. Odeh
- Stritch School of Medicine, Loyola University Chicago, Chicago, IL, USA
- Department of Thoracic & Cardiovascular Surgery, Loyola University Medical Center, Maywood, IL, USA
| | - Kody Wyant
- Stritch School of Medicine, Loyola University Chicago, Chicago, IL, USA
- Department of Thoracic & Cardiovascular Surgery, Loyola University Medical Center, Maywood, IL, USA
| | - Richard K. Freeman
- Stritch School of Medicine, Loyola University Chicago, Chicago, IL, USA
- Department of Thoracic & Cardiovascular Surgery, Loyola University Medical Center, Maywood, IL, USA
| | - Zaid M. Abdelsattar
- Stritch School of Medicine, Loyola University Chicago, Chicago, IL, USA
- Department of Thoracic & Cardiovascular Surgery, Loyola University Medical Center, Maywood, IL, USA
- US Department of Veterans Affairs, Edward Hines Jr. VA Hospital, Hines, IL, USA
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Rodier S, Henning J, Kukreja J, Mohammedi T, Shah P, Damani T. Robotic Primary and Revisional Hiatal Hernia Repair is Safe and Associated with Favorable Perioperative Outcomes: A Single Institution Experience. J Laparoendosc Adv Surg Tech A 2023; 33:932-936. [PMID: 37417969 DOI: 10.1089/lap.2023.0218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023] Open
Abstract
Background: Robotic hiatal hernia (HH) repair has been demonstrated to be feasible and safe. Recent conflicting reports have emerged on the higher incidence of perioperative complications with robotic HH repair when compared with laparoscopic repair. Materials and Methods: A retrospective review of a prospective database at an academic medical center for all robotic HH repairs performed by a high-volume foregut surgeon from 2018 to 2021 was performed. Outcome measures included operative time, estimated blood loss (EBL), length of stay (LOS), conversion rate, need for esophageal lengthening procedure, intra- and perioperative complications, and 30-day in-hospital mortality. Results: One hundred four patients were included in the analysis. Fifteen percent of patients had a type I HH, 2% had a type II, 73% had a type III, and 10% had a type IV HH. Eighty-four percent of cases were primary and 16% were revisional. Fifty-four percent of patients had mesh placed and 4.4% had an esophageal lengthening procedure. Mean EBL was 15 mL and mean operative time was 151 minutes. Median LOS was 2 days (interquartile range 1-2 days). There were zero conversions. Intraoperative complication rate was 1% and 30-day complication rate was 4%. The 30-day in-hospital mortality was zero. Conclusion: In this retrospective analysis of 114 consecutive robotic HH repairs performed, with 83% type III or IV HHs and 16% revisional hiatal cases, our results demonstrate favorable perioperative outcomes, with lower EBL, shorter LOS, lower complication rate, zero conversions, and comparable operative times compared with historical laparoscopic data.
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Affiliation(s)
- Simon Rodier
- Department of Surgery, NYU Langone Health, New York, New York, USA
| | - Justin Henning
- Department of Surgery, NYU Langone Health, New York, New York, USA
| | - Janvi Kukreja
- Division of the Biological Sciences, University of Chicago, Chicago, Illinois, USA
| | - Taher Mohammedi
- Department of Surgery, NYU Langone Health, New York, New York, USA
| | - Paresh Shah
- Department of Surgery, NYU Langone Health, New York, New York, USA
| | - Tanuja Damani
- Department of Surgery, NYU Langone Health, New York, New York, USA
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4
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Elissavet S, Ioannis G, Panagiotis P, Konstantinos M, Apostolos K. Robotic-assisted versus laparoscopic paraesophageal hernia repair: a systematic review and meta-analysis. JOURNAL OF MINIMALLY INVASIVE SURGERY 2023; 26:134-145. [PMID: 37712313 PMCID: PMC10505365 DOI: 10.7602/jmis.2023.26.3.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 08/15/2023] [Accepted: 09/06/2023] [Indexed: 09/16/2023]
Abstract
Purpose The robotic approach offers improved visualization and maneuverability for surgeons. This systematic review aims to compare the outcomes of robotic-assisted and conventional laparoscopic approaches for paraesophageal hernia repair, specifically examining postoperative complications, operative time, hospital stay, and recurrence. Methods A systematic review including thorough research through PubMed, Scopus, and Cochrane, was performed and only comparative studies were included. Studies concerning other types of hiatal hernias or children were excluded. A meta-analysis was conducted to compare overall postoperative complications, hospital stay, and operation time. Results Ten comparative studies, with 186,259 participants in total, were included in the meta-analysis, but unfortunately, not all of them reported all the outcomes under question. It appeared that there is no statistically significant difference between the conventional laparoscopic and the robotic-assisted approach, regarding the overall postoperative complication rate (odds ratio [OR], 0.56, 95% confidence interval [CI], 0.28-1.11), the mean operation time (t = 1.41; 95% CI, -0.15-0.52; p = 0.22), and the hospital length of stay (t = -1.54; degree of freedom = 8; 95% CI, -0.53-0.11; p = 0.16). Only two studies reported evidence concerning the recurrence rates. Conclusion Overall, the robotic-assisted method did not demonstrate superiority over conventional laparoscopic paraesophageal hiatal hernia repair in terms of postoperative complications, operation time, or hospital stay. However, some studies focused on cost and patient characteristics of each group. Further comparative and randomized control studies with longer follow-up periods are needed for more accurate conclusions on short- and long-term outcomes.
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Affiliation(s)
- Symeonidou Elissavet
- 5th Department of Surgery, Ippokratio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Gkoutziotis Ioannis
- 5th Department of Surgery, Ippokratio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Petras Panagiotis
- 5th Department of Surgery, Ippokratio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Mpallas Konstantinos
- 5th Department of Surgery, Ippokratio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Kamparoudis Apostolos
- 5th Department of Surgery, Ippokratio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Panse NS, Prasath V, Quinn PL, Chokshi RJ. Economic evaluation of robotic and laparoscopic paraesophageal hernia repair. Surg Endosc 2023; 37:6806-6817. [PMID: 37264228 DOI: 10.1007/s00464-023-10119-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 05/08/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND Robotic approach in paraesophageal hernia (PEH) repair may improve outcomes over laparoscopic approach, though at additional cost. This study aimed to compare cost-effectiveness of robotic and laparoscopic PEH repair. METHODS A decision tree was created analyzing cost-effectiveness of robotic and laparoscopic PEH repair. Costs were obtained from 2021 Medicare data and were accumulated within 60 months after surgery. Effectiveness was measured in quality-adjusted life-years (QALYs). Branch-point probabilities and costs of robotic surgery consumables were obtained from published literature. The primary outcome of interest was incremental cost-effectiveness ratio (ICER). One-way, two-way, and probabilistic sensitivity analyses were performed. A secondary analysis including attributable capital and maintenance costs of robotic surgery was conducted as well. RESULTS Laparoscopic repair yielded 3.660 QALYs at $35,843.82. Robotic repair yielded 3.661 QALYs at $36,342.57, with an ICER of $779,488.62/QALY. Robotic repair was favored when rates of open conversion and symptom recurrence were low, or with reduced cost of robotic instruments. A probabilistic sensitivity analysis favored laparoscopic repair in 100% of simulations. When accounting for costs of robotic technology, robotic approach was preferred only in unrealistic clinical scenarios. CONCLUSIONS Laparoscopic repair is likely more cost-effective for most institutions, though results were relatively similar. With experienced surgeons who surpass the initial learning curve, robotic surgery may improve outcomes enough to be cost-effective, but only when excluding capital and maintenance fees.
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Affiliation(s)
- Neal S Panse
- Division of Surgical Oncology, Department of Surgery, Rutgers New Jersey Medical School, 185 South Orange Avenue, Newark, NJ, 07103, USA
| | - Vishnu Prasath
- Rutgers New Jersey Medical School, 185 South Orange Avenue, Newark, NJ, 07103, USA
| | - Patrick L Quinn
- Department of Surgery, The Ohio State University Wexner Medical Center, 410 West 10th Avenue, Columbus, OH, 43210, USA
| | - Ravi J Chokshi
- Division of Surgical Oncology, Department of Surgery, Rutgers New Jersey Medical School, 185 South Orange Avenue, Newark, NJ, 07103, USA.
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Vigneswaran Y, Bryan AF, Ruhle B, Gottlieb LJ, Alverdy J. Autologous Posterior Rectus Sheath as a Vascularized Onlay Flap: a Novel Approach to Hiatal Hernia Repair. J Gastrointest Surg 2022; 26:268-274. [PMID: 34506032 PMCID: PMC8760196 DOI: 10.1007/s11605-021-05134-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 08/21/2021] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Complex and recurrent paraesophageal hernia repairs are a challenge for surgeons due to their high recurrence rates despite the use of various prosthetic and suturing techniques. METHODS Here we describe the use of vascularized fascia harvested from the posterior rectus sheath with peritoneum during robotic hiatal hernia repair in two patients with large complex diaphragmatic defects. RESULTS Successful harvesting and onlay of the right posterior rectus sheath based on a falciform vascular pedicle was achieved robotically by rotating and securing the flap to the diaphragmatic hiatus as an onlay flap following cruroplasty of the hiatal defect. CONCLUSIONS In patients with difficult to repair large paraesophageal hernias, we demonstrate a promising new technique to restore the dynamic hiatal complex with the tensile strength of autologous vascularized fascia and peritoneum.
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Affiliation(s)
- Yalini Vigneswaran
- grid.412578.d0000 0000 8736 9513Sections of Minimally Invasive Surgery and Plastic Reconstructive Surgery, Department of Surgery, University of Chicago Medical Center, 5841 S Maryland Ave, MC5095, Chicago, IL 60637 USA
| | - Ava F. Bryan
- grid.412578.d0000 0000 8736 9513Sections of Minimally Invasive Surgery and Plastic Reconstructive Surgery, Department of Surgery, University of Chicago Medical Center, 5841 S Maryland Ave, MC5095, Chicago, IL 60637 USA
| | - Brian Ruhle
- grid.412578.d0000 0000 8736 9513Sections of Minimally Invasive Surgery and Plastic Reconstructive Surgery, Department of Surgery, University of Chicago Medical Center, 5841 S Maryland Ave, MC5095, Chicago, IL 60637 USA
| | - Lawrence J. Gottlieb
- grid.412578.d0000 0000 8736 9513Sections of Minimally Invasive Surgery and Plastic Reconstructive Surgery, Department of Surgery, University of Chicago Medical Center, 5841 S Maryland Ave, MC5095, Chicago, IL 60637 USA
| | - John Alverdy
- grid.412578.d0000 0000 8736 9513Sections of Minimally Invasive Surgery and Plastic Reconstructive Surgery, Department of Surgery, University of Chicago Medical Center, 5841 S Maryland Ave, MC5095, Chicago, IL 60637 USA
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7
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Lin EL, Sibona A, Peng J, Singh PN, Wu E, Michelotti MJ. Cumulative summation analysis of learning curve for robotic-assisted hiatal hernia repairs. Surg Endosc 2021; 36:3442-3450. [PMID: 34327550 DOI: 10.1007/s00464-021-08665-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 07/20/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Robotic-assisted laparoscopic surgery (RALS) is evolving as an important surgical approach in the field of general surgery. We aimed to evaluate the learning curve for RALS procedures involving repair of hiatal hernias. METHODS A series of robotic-assisted hiatal hernia (HH) repairs were performed between 2013 and 2017 by a surgeon at a single institution. Data were entered into a retrospective database. Patient demographics and intraoperative parameters including console time (CT), surgery time (ST), and total operative time (OT) were examined and abstracted for learning curve analysis using the cumulative sum (CUSUM) method. Assessment of perioperative and post-operative outcomes were calculated using descriptive statistics. RESULTS The average age of the patients was 57.4 years, average BMI was 29.9 kg/m2, median American Society of Anesthesiologists (ASA) classification was 2, and average Charlson Comorbidity Index (CCI) score was 2.8. The series had a mean CT of 132.6 min, mean ST of 145.1 min, and mean OT of 197.4 min. The CUSUM learning curve for CT was best approximated as a third-order polynomial consisting of three unique phases: the initial training phase (case 1-40), the improvement phase (case 41-85), and the mastery phase (case 86 onwards). There was no significant difference in perioperative complications between the phases. Short-term clinical outcomes were comparable with national standards and did not correlate significantly with operative experience. CONCLUSIONS The three phases identified with CUSUM analysis represented characteristic stages of the learning curve for robotic hiatal hernia procedures. Our data suggest the training phase is achieved after 40 cases and a high level of mastery is achieved after approximately 85 cases. Thus, the CUSUM method serves as a useful tool for objectively evaluating practical skills for surgeons and can ultimately help establish milestones that assess surgical competency during robotic surgery training.
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Affiliation(s)
- Emily L Lin
- Department of General Surgery, Loma Linda University Health, Loma Linda, CA, USA.
| | - Agustin Sibona
- Department of General Surgery, Loma Linda University Health, Loma Linda, CA, USA
| | - Jiahao Peng
- Center for Health Research, Loma Linda University School of Public Health, Loma Linda, CA, USA
| | - Pramil N Singh
- Center for Health Research, Loma Linda University School of Public Health, Loma Linda, CA, USA
| | - Esther Wu
- Department of General Surgery, Loma Linda University Health, Loma Linda, CA, USA
| | - Marcos J Michelotti
- Department of General Surgery, Loma Linda University Health, Loma Linda, CA, USA
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Obisesan A, Singhal V, Satoskar S. Robotic-assisted hiatal hernia repair and pulmonary embolism: an institution-based retrospective cohort study. J Robot Surg 2021; 16:501-505. [PMID: 34148191 DOI: 10.1007/s11701-021-01264-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 06/09/2021] [Indexed: 10/21/2022]
Abstract
Hiatal hernia (HH) is an abnormal protrusion of components of the abdominal viscera through the esophageal hiatus. The laparoscopic approach is the gold standard for repair with the robotic technique now gaining wide acceptance. Pulmonary embolism (PE) is a well-known post-operative complication but its incidence following robotically assisted HH repairs is not well known. This study provides a descriptive analysis of three patients who developed PE after robotic repairs of their HHs. The incidence of PE in the studied cohort was 2.7% (3 of 112) with a male preponderance (66.7%). The mean age of the patients was 55.3 years with a mean BMI of 32.2 kg/m2. The average duration of surgery was 4.2 h with sizes of the diaphragmatic defects ranging from 3 to 6 cm. Confirmatory PE diagnosis was made with a chest CT angiogram and the mean length of hospital stay was 4 days. PE although rare, is a preventable cause of in-patient mortality and morbidity with implications on healthcare costs and hospital resource use. The Caprini model provides a guide to pre-operative patient risk stratification and PE prevention, and the patients in this study were in the moderate to high-risk groups. Risk factors common to all patients were: age > 40 years, BMI > 30 kg/m2 and duration of surgery > 2 h with one of the patients having a previous history of PE. There are no established PE chemoprophylaxis guidelines for robotic HH repairs and in this cohort, heparin was commenced 6-8 h post-operatively. Thus, there is a need for a consensus chemoprophylaxis guideline in this subset of surgical patients. PE following robotic HH repair is associated with prolonged hospital stay and increased healthcare costs. Guidelines for effective pre-operative chemoprophylaxis for these repairs are needed to optimize patient outcomes.
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Affiliation(s)
- Aanuoluwapo Obisesan
- Department of Surgery, St. Luke's University Health Network, Bethlehem, PA, USA.
| | - Vinay Singhal
- Department of Surgery, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Savni Satoskar
- Department of Surgery, St. Luke's University Health Network, Bethlehem, PA, USA
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Salfity H, Hartwig MG. The Robotic Method of Repairing Dysphagia. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2020; 15:225-228. [PMID: 32412319 DOI: 10.1177/1556984520921957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Hai Salfity
- 3065 Department of Surgery, Division of Cardiothoracic Surgery, Duke University Hospital, Durham, NC, USA
| | - Matthew G Hartwig
- 3065 Department of Surgery, Duke University School of Medicine, Durham, NC, USA
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Gupta AK, Pansari M, Yi S, Genuit T, Rodriguez A. Transdiaphragmatic-pericardial Hernia: Case Report of an Unusual Condition Managed by Utilization of a Robotic Surgical System. Cureus 2020; 12:e7689. [PMID: 32431969 PMCID: PMC7233519 DOI: 10.7759/cureus.7689] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Transdiaphragmatic hernia via the central tendon in the pericardium is a rare entity. Most often, these hernias are acquired and related to the iatrogenic creation of a transdiaphragmatic-pericardial defect. We would like to present a case of a 62-year-old male who presented with acute chest pain and was diagnosed to have a transdiaphragmatic-pericardial hernia on computed tomography. He has a history of cardiac intervention via an abdominal approach 12 years earlier. A segment of jejunum was found strangulated in the defect. We used DaVinci Xi® (Intuitive Surgical, Sunnyvale, CA) robot and were able to successfully reduce the hernia, repair the defect, and resect a short segment of jejunum which was non-viable. The utilization of a minimally invasive approach may be feasible, and the use of a robotic surgical system may enhance the surgeon’s ability to repair the defect.
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Affiliation(s)
- Anupam K Gupta
- Surgery, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, USA
| | - Mridul Pansari
- Surgery, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, USA
| | - Slee Yi
- Surgery, Florida Atlantic University, Boca Raton, USA
| | - Thomas Genuit
- Surgery, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, USA
| | - Ariel Rodriguez
- Surgery, Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, USA
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Hosein S, Carlson T, Flores L, Armijo PR, Oleynikov D. Minimally invasive approach to hiatal hernia repair is superior to open, even in the emergent setting: a large national database analysis. Surg Endosc 2020; 35:423-428. [PMID: 32040632 DOI: 10.1007/s00464-020-07404-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 01/30/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND We aimed to examine the outcomes and utilization of different hiatal hernia repair (HHR) approaches in elective and emergent/urgent settings. METHODS Vizient 2015-2017 database was queried for adult patients who underwent HHR. Patients were grouped into open (OHHR), laparoscopic (LHHR), or robotic-assisted (RHHR), and further stratified by elective or urgent status and severity of illness at admission. Surgical outcomes and costs were compared across all groups. Statistical analysis were done using SPSS v.25.0. RESULTS 9171 adults were included (OHHR N = 1534;LHHR N = 6796;RHHR N = 841). LHHR was the most utilized approach (74.1%), followed by OHRR (16.7%) and RHHR (9.2%). OHHR was employed three times as frequently in U settings, compared to elective. Overall, OHHR had longer mean length of stay (LOS; 9.41 vs. < 4 days) and higher postoperative complication rates (8.8% vs < 3.8%), mortality (2.7% vs < 0.5%) and mean direct cost ($27,842 vs < $10,407), when compared to both LHHR and RHHR, all p < 0.05. Analysis of mild to severely ill elective cases demonstrated LHHR and RHHR to be better than OHHR regarding complications (p < 0.05), cost (p < 0.001) and LOS (p < 0.013); there were insufficient extremely ill elective patients for meaningful analysis. In the urgent setting, minimally invasive approaches predominate, overtaken by OHHR only for the extremely ill. Despite the urgent setting, for mild-moderately ill patients, OHHR was statistically inferior to both LHHR and RHHR for LOS (p = 0.002, p < 0.0001) and cost (p = 0.0133, p < 0.001). In severe-extremely ill patients, despite being more utilized, OHHR was not superior to LHHR; in fact, complication, cost, and mortality trends (all p > 0.05) favored LHHR. CONCLUSION Our analysis demonstrated LHHR to currently be the most employed approach overall. LHHR and RHHR were associated with lower cost, decreased LOS, complications, and mortality compared to OHHR, in all but the sickest of patients. Patients should be offered minimally invasive HHR, even in urgent/emergent settings, if technically feasible.
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Affiliation(s)
- Salim Hosein
- Center for Advanced Surgical Technology, University of Nebraska Medical Center, Omaha, NE, USA.,Department of Surgery, General Surgery, University of Nebraska Medical Center, Omaha, NE, USA
| | - Tyson Carlson
- College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Laura Flores
- Center for Advanced Surgical Technology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Priscila Rodrigues Armijo
- Center for Advanced Surgical Technology, University of Nebraska Medical Center, Omaha, NE, USA.,Department of Surgery, General Surgery, University of Nebraska Medical Center, Omaha, NE, USA
| | - Dmitry Oleynikov
- Center for Advanced Surgical Technology, University of Nebraska Medical Center, Omaha, NE, USA. .,Department of Surgery, General Surgery, University of Nebraska Medical Center, Omaha, NE, USA. .,Minimally Invasive and Bariatric Surgery, Department of General Surgery, University of Nebraska Medical Center, 986246 Nebraska Medical Center, Omaha, NE, 68198-6246, USA.
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12
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Sowards KJ, Holton NF, Elliott EG, Hall J, Bajwa KS, Snyder BE, Wilson TD, Mehta SS, Walker PA, Chandwani KD, Klein CL, Rivera AR, Wilson EB, Shah SK, Felinski MM. Safety of robotic assisted laparoscopic recurrent paraesophageal hernia repair: insights from a large single institution experience. Surg Endosc 2019; 34:2560-2566. [PMID: 31811451 DOI: 10.1007/s00464-019-07291-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Accepted: 11/28/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Laparoscopic repair of recurrent as opposed to primary paraesophageal hernias (PEHs) are historically associated with increased peri-operative complication rates, worsened outcomes, and increased conversion rates. The robotic platform may aid surgeons in these complex revision procedures. The aim of this study was to compare the outcomes of patients undergoing robotic assisted laparoscopic (RAL) repair of recurrent as opposed to primary PEHs. METHODS Patients undergoing RAL primary and recurrent PEH repairs from 2009 to 2017 at a single institution were reviewed. Demographics, use of mesh, estimated blood loss, intra-operative complications, conversion rates, operative time, rates of esophageal/gastric injury, hospital length of stay, re-admission/re-operation rates, recurrence, dysphagia, gas bloat, and pre- and post-operative proton pump inhibitor (PPI) use were analyzed. Analysis was accomplished using Chi-square test/Fischer's exact test for categorical variables and the Mann-Whitney U test for continuous variables. RESULTS There were 298 patients who underwent RAL PEH repairs (247 primary, 51 recurrent). They were followed for a median (interquartile range) of 120 (44, 470) days. There were no significant differences in baseline demographics between groups. Patients in the recurrent PEH group had longer operative times, increased use of mesh, and increased length of hospital stay. They were also less likely to undergo fundoplication. There were no significant differences in estimated blood loss, incidence of intra-operative complications, re-admission rates, incidence of post-operative dysphagia and gas bloat, and incidence of post-operative PPI use. There were no conversions to open operative intervention or gastric/esophageal injury/leaks. CONCLUSIONS Although repair of recurrent PEHs are historically associated with worse outcomes, in this series, RAL recurrent PEH repairs have similar peri-operative and post-operative outcomes as compared to primary PEH repairs. Whether this is secondary to the potential advantages afforded by the robotic platform deserves further study.
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Affiliation(s)
- Kendell J Sowards
- Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 4.156, Houston, TX, 77030, USA
| | - Nicholas F Holton
- Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 4.156, Houston, TX, 77030, USA
| | - Ekatarina G Elliott
- Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 4.156, Houston, TX, 77030, USA
| | - John Hall
- Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 4.156, Houston, TX, 77030, USA
| | - Kulvinder S Bajwa
- Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 4.156, Houston, TX, 77030, USA
| | - Brad E Snyder
- Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 4.156, Houston, TX, 77030, USA
| | - Todd D Wilson
- Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 4.156, Houston, TX, 77030, USA
| | | | | | - Kavita D Chandwani
- Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 4.156, Houston, TX, 77030, USA
| | - Connie L Klein
- Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 4.156, Houston, TX, 77030, USA
| | - Angielyn R Rivera
- Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 4.156, Houston, TX, 77030, USA
| | - Erik B Wilson
- Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 4.156, Houston, TX, 77030, USA
| | - Shinil K Shah
- Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 4.156, Houston, TX, 77030, USA. .,Michael E. DeBakey Institute for Comparative Cardiovascular Science and Biomedical Devices, Texas A&M University, College Station, TX, USA.
| | - Melissa M Felinski
- Department of Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 4.156, Houston, TX, 77030, USA
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13
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Giovannetti A, Craigg D, Castro M, Ross S, Sucandy I, Rosemurgy A. Laparoendoscopic Single-Site (LESS) versus Robotic “Redo” Hiatal Hernia Repair with Fundoplication: Which Approach is Better? Am Surg 2019. [DOI: 10.1177/000313481908500939] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Only a small percentage of patients fail laparoscopic fundoplications undertaken for gastroesophageal reflux disease. But because many laparoscopic fundoplications have been undertaken, surgeons frequently encounter patients in need of “redo” operations. This study was undertaken to evaluate the robotic approach versus laparoendoscopic single-site (LESS) approach for redo fundoplications. With an Institutional Review Board approval, 64 patients undergoing LESS (n = 32) or robotic (n = 32) redo antireflux operations were prospectively followed up. Data are presented as median (mean + SD). For LESS versus robotic redo operations, the operative duration was 145 (143 ± 33.5) versus 196 (208 ± 76.7) minutes ( P < 0.01), estimated blood loss was 50 (80 ± 92.1) versus 20 (43 ± 57.1) mL ( P = 0.07), and length of stay was 1 (3 ± 5.4) versus 1 (2 ± 1.9) day ( P = 0.57); 1 LESS operation was converted to “open.” Operative duration was longer for men ( P = 0.01). Postoperative complications were not more frequent after Nissen (n = 36) or Toupet (n = 28) fundoplication, regardless of the approach. When matched by BMI, operative duration was prolonged by a large Type I to IV hiatal hernia ( P = 0.01). Symptoms improved dramatically and were similar with both approaches, and patient satisfaction was high. Robotic redo antireflux operations take longer than LESS operations. LESS and robotic redo antireflux operations are both safe and offer significant and similar amelioration of symptoms after failed fundoplications.
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Affiliation(s)
| | - Danielle Craigg
- From the Department of Surgery, Florida Hospital Tampa, Tampa, Florida
| | - Miguel Castro
- From the Department of Surgery, Florida Hospital Tampa, Tampa, Florida
| | - Sharona Ross
- From the Department of Surgery, Florida Hospital Tampa, Tampa, Florida
| | - Iswanto Sucandy
- From the Department of Surgery, Florida Hospital Tampa, Tampa, Florida
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14
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Abstract
The Caribbean region is part of the world which lagged by 10 years compared to the rest of the developed world nations in the field of minimal access surgery (MAS). The implementation of basic and advanced laparoscopy only came to fruition until a group of surgeons created a partnership across the region. The introduction of robotic surgery to the world possess yet another challenge to the surgical leaders and the people of the developing Caribbean countries.
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Affiliation(s)
- Jorge Rabaza
- South Miami Hospital, Weight-loss Surgery Program, 6200 SW 73 Street, South Miami, Florida, 33143, USA.
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15
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Dallemagne B, Quero G, Lapergola A, Guerriero L, Fiorillo C, Perretta S. Treatment of giant paraesophageal hernia: pro laparoscopic approach. Hernia 2017; 22:909-919. [PMID: 29177588 DOI: 10.1007/s10029-017-1706-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 11/18/2017] [Indexed: 12/20/2022]
Abstract
PURPOSE Giant paraesophageal hernias (GPEH) are relatively uncommon and account for less than 5% of all primary hiatal hernias. Giant Secondary GPEH can be observed after surgery involving hiatal orifice opening, such as esophagectomy, antireflux surgery, and hiatal hernia repair. Surgical treatment is challenging, and there are still residual controversies regarding the laparoscopic approach, even though a reduced morbidity and mortality, as well as a shorter hospital stay have been demonstrated. METHODS A Pubmed electronic search of the literature including articles published between 1992 and 2016 was conducted using the following key words: hiatal hernia, paraesophageal hernias, mesh, laparoscopy, intrathoracic stomach, gastric volvulus, diaphragmatic hernia. RESULTS Given the risks of non-operative management, GPEH surgical repair is indicated in symptomatic patients. Technical steps for primary hernia repair include hernia reduction and sac excision, correct repositioning of the gastroesophageal junction, crural repair, and fundoplication. For secondary hernias, the surgical technique varies according to hernia type and components and according to the approach used during the first surgery. There is an ongoing debate regarding the best and safest method to close the hiatal orifice. The laparoscopic approach has demonstrated a lower postoperative morbidity and mortality, and a shorter hospital stay as compared to the open approach. A high recurrence rate has been reported for primary GPEH repair. However, recent studies suggest that recurrence does not reduce symptomatic outcomes. CONCLUSIONS The laparoscopic treatment of primary and secondary GPEH is safe and feasible in elective and emergency settings, especially in high-volume centers. The procedure is still challenging. The main steps are well defined. However, there is still room for improvement to lower the recurrence rate.
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Affiliation(s)
- B Dallemagne
- IRCAD, 1 Place de l'Hôpital, 67091, Strasbourg Cedex, France. .,Institute of Image Guided Surgery/IHU Strasbourg, 1 Place de l'Hôpital, 67091, Strasbourg Cedex, France.
| | - G Quero
- Institute of Image Guided Surgery/IHU Strasbourg, 1 Place de l'Hôpital, 67091, Strasbourg Cedex, France
| | - A Lapergola
- Institute of Image Guided Surgery/IHU Strasbourg, 1 Place de l'Hôpital, 67091, Strasbourg Cedex, France
| | - L Guerriero
- Institute of Image Guided Surgery/IHU Strasbourg, 1 Place de l'Hôpital, 67091, Strasbourg Cedex, France
| | - C Fiorillo
- Institute of Image Guided Surgery/IHU Strasbourg, 1 Place de l'Hôpital, 67091, Strasbourg Cedex, France
| | - S Perretta
- IRCAD, 1 Place de l'Hôpital, 67091, Strasbourg Cedex, France.,Institute of Image Guided Surgery/IHU Strasbourg, 1 Place de l'Hôpital, 67091, Strasbourg Cedex, France
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16
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Jindal S, Hukkeri VS, Qaleem M, Tandon V, Govil D. Robotic repair of a parahiatal hernia with gastric volvulus. APOLLO MEDICINE 2016. [DOI: 10.1016/j.apme.2016.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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17
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Wang WP, Ni PZ, Chen LQ. Laparoscopic surgical treatment of esophageal hiatal hernia. Shijie Huaren Xiaohua Zazhi 2016; 24:3087-3097. [DOI: 10.11569/wcjd.v24.i20.3087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Types II, III and IV esophageal hiatal hernia (EHH) which presents obvious symptoms or leads to potentially fatal complications requires surgical treatment. Laparoscopy has been used to repair EHH in the last two decades globally and proved to be minimally invasive compared to conventional open surgery. This review summarizes current status and prospectives of laparoscopic application in EHH treatment. The published articles on minimally invasive laparoscopic surgical treatment of EHH in PubMed, Cochrane Library and EMBASE databases were retrieved and analyzed. From 1992 to 2015, 86 English articles involving a total of 4771 patients receiving laparoscopic treatment for EHH were retrieved. Perioperative information including safety and feasibility of procedure, postoperative complications, and short/long-term outcome after laparoscopic repair was retrospectively analyzed. Laparoscopic surgical treatment of EHH is a safe, feasible and minimally invasive procedure with fast recovery after repair, low postoperative morbidity and recurrence.
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18
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Brenkman HJF, Parry K, van Hillegersberg R, Ruurda JP. Robot-Assisted Laparoscopic Hiatal Hernia Repair: Promising Anatomical and Functional Results. J Laparoendosc Adv Surg Tech A 2016; 26:465-9. [PMID: 27078499 DOI: 10.1089/lap.2016.0065] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND There is no consensus on the optimal technique for hiatal hernia (HH) repair, and considerable recurrence rates are reported. The aim of this study was to evaluate the perioperative outcomes, quality of life (QoL), and recurrence rate in patients undergoing robot-assisted laparoscopic HH repair. MATERIALS AND METHODS All patients who underwent robot-assisted laparoscopic HH repair between July 2011 and March 2015 were evaluated. The procedure consisted of hernia sac reduction, crural repair without mesh, and Toupet fundoplication. Postoperative radiological imaging or endoscopy was performed in all symptomatic patients to exclude recurrence. Perioperative results were collected retrospectively from the patient records. QoL was evaluated with Short Form-36 (SF-36), Gastroesophageal Reflux Disease-Health-Related Quality of Life (GERD-HRQOL), and Gastrointestinal Quality of Life Index (GIQLI) questionnaires. RESULTS A total of 40 patients were identified. The majority (75%) had a type III HH. Median operation time was 118 (62-173) minutes; median blood loss was 20 (10-934) mL, and one procedure was converted to an open procedure. In 6 (15%) patients, postoperative complications occurred, including 2 grade II and 1 grades I, III, IV, and V, according to the Clavien-Dindo classification. Median hospital stay was 3 (1-15) days. At a median follow-up of 11 months, radiological imaging was performed on indication in 12 (30%) patients, and 1 recurrence was found. Overall QoL scores were satisfactory, and there was no difference related to the time elapsed since surgery. CONCLUSION Robot-assisted laparoscopic HH repair followed by Toupet fundoplication demonstrated a very low short-term recurrence rate. Postoperative morbidity was minimal, and a satisfactory QoL was achieved.
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Affiliation(s)
- Hylke J F Brenkman
- Department of Surgery, University Medical Center Utrecht , Utrecht, The Netherlands
| | - Kevin Parry
- Department of Surgery, University Medical Center Utrecht , Utrecht, The Netherlands
| | | | - Jelle P Ruurda
- Department of Surgery, University Medical Center Utrecht , Utrecht, The Netherlands
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19
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Sarkaria IS, Latif MJ, Bianco VJ, Bains MS, Rusch VW, Jones DR, Rizk NP. Early operative outcomes and learning curve of robotic assisted giant paraesophageal hernia repair. Int J Med Robot 2016; 13. [PMID: 26928955 DOI: 10.1002/rcs.1730] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 12/14/2015] [Accepted: 12/21/2015] [Indexed: 01/01/2023]
Abstract
BACKGROUND We have previously described our technique of robotic-assisted giant paraesophageal hernia repair (RA-GPEHR). The purpose of this study was to report our initial experience, early outcomes and learning curve with RA-GPEHR using a four-arm robotic platform. METHODS 24 consecutive patients presenting with symptomatic giant paraesophageal hernias (GPEH) underwent RA-GPEHR from April 2011 to February 2014. Peri-operative data and short-term patient outcomes were assessed by retrospective review of a prospectively maintained database. RESULTS Median age was 62 years (range 44-84). 15 (63%) patients underwent fundoplication and 9 (37%) gastropexy. Median procedure time was 277 min (range: 185-485) and decreased steadily over the experience. There were no intra-operative complications or surgical mortality. No patients experienced dysphagia in the early post-operative period. CONCLUSIONS RA-GPEHR is safe, with reported short-term operative and functional outcomes similar to conventional laparoscopic approaches. The initial learning curve appears relatively short for experienced minimally invasive esophageal surgeons. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Inderpal S Sarkaria
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - M Jawad Latif
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Valentino J Bianco
- Department of Cardiothoracic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Manjit S Bains
- Thoracic Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Valerie W Rusch
- Thoracic Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - David R Jones
- Thoracic Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Nabil P Rizk
- Thoracic Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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20
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Prasad A, Aggarwal RK, Tiwari A, Hukkeri VS. Robotic-assisted hiatal hernia surgery with the da Vinci system: A 2-year experience in a single institution. APOLLO MEDICINE 2015. [DOI: 10.1016/j.apme.2015.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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21
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Tolboom R, Broeders I, Draaisma W. Robot-assisted laparoscopic hiatal hernia and antireflux surgery. J Surg Oncol 2015; 112:266-70. [DOI: 10.1002/jso.23912] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 03/08/2015] [Indexed: 12/22/2022]
Affiliation(s)
- R.C. Tolboom
- Meander Medical Centre; Department of Surgery; Amersfoort The Netherlands
- University of Twente; Robotics and Minimal Invasive Surgery; Enschede The Netherlands
| | - I.A.M.J. Broeders
- Meander Medical Centre; Department of Surgery; Amersfoort The Netherlands
- University of Twente; Robotics and Minimal Invasive Surgery; Enschede The Netherlands
| | - W.A. Draaisma
- Meander Medical Centre; Department of Surgery; Amersfoort The Netherlands
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22
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Morelli L, Guadagni S, Mariniello MD, Pisano R, D'Isidoro C, Belluomini MA, Caprili G, Di Candio G, Mosca F. Robotic giant hiatal hernia repair: 3 year prospective evaluation and review of the literature. Int J Med Robot 2014; 11:1-7. [PMID: 24869751 DOI: 10.1002/rcs.1595] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 04/10/2014] [Accepted: 04/11/2014] [Indexed: 02/05/2023]
Abstract
BACKGROUND While conventional laparoscopic repair for giant hiatal hernias is considered difficult, robotic technology is likely to result in an improved postoperative course. METHODS We prospectively analysed patients with giant hiatal hernias who underwent robotic repair during a 3 year period. Preoperative data, operative variables, complications, clinical outcomes and anatomical recurrence after 1 year were evaluated. RESULTS Six patients with giant hiatal hernias underwent robotic repair using the Da Vinci surgical system. The mean operative time was 182 min. The mean hospital stay was 6 days. No patients required reoperation for disease recurrence, and all claimed the absence of postoperative symptoms. CONCLUSIONS Robotic approaches can minimize surgical trauma in patients with giant hiatal hernias and result in favourable outcomes in terms of anatomical recurrence and quality of life. With the availability of the da Vinci System, all patients with giant hiatal hernias can be offered a minimally invasive surgical option.
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Affiliation(s)
- Luca Morelli
- General Surgery unit, Department of Oncology, Transplantation and New Technologies, University of Pisa, Italy; EndoCAS (Centre for Computer Assisted Surgery), University of Pisa, Italy
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