Advertisement

Journal of Robotic Surgery

, Volume 5, Issue 1, pp 29–33 | Cite as

Surgical treatment of hiatus hernia and gastroesophageal reflux disease in complex cases using robotic-assisted laparoscopic surgery: a prospective study/consistent experience in a single institution

  • Vladimir Schraibman
  • Antonio Luiz de Vasconcellos Macedo
  • Samuel Okazaki
  • Fernando Concilio Mauro
  • Marina Gabrielle Epstein
  • Suzan Menasce Goldman
  • Suzana Lustosa
  • Delcio Matos
Original Article

Abstract

The aim of this study was to report our experience in robotic-assisted surgery of hiatus hernia and gastroesophageal reflux disease in a large series of complex cases. From March 2009 until July 2010, 21 patients were operated due to hiatus hernia or reflux disease using robotic-assisted surgery at Albert Einstein Hospital, São Paulo, Brazil. All patients were selected for the robotic approach because of the complexity of the cases (associated co-morbidity) such as: previous major upper abdominal surgery in 6 patients, hiatus hernia with paraesophageal involvement in 8 patients, obesity with a body mass index of over 29 kg/m2 in 8 patients, and previous hiatus hernioplasty in 3 patients. Optimal trocar positioning, operating and setup times, conversion rate, intraoperative complications, and perioperative morbidity and mortality rate were analyzed. The mean operating time was reduced from 316 to 195 min after five procedures and the setup time from 20 to 10 min after five procedures. There were no conversions in this group of patients and also no complication or need of blood transfusion. Robotic-assisted fundoplication is feasible, safe and effective for treating hiatus hernias and gastroesophageal reflux disease, especially in complex cases because improved dissection in the esophageal hiatus region compensates for long operating times. Disadvantages are the high costs, the time to master the setup/system, and the necessity of exact trocar positioning.

Keywords

Hiatus hernia Robotic surgery Technique Recurrence 

References

  1. 1.
    Stylopoulos N, Rattner D (2005) The history of hiatal hernia surgery: from Bowditch to laparoscopy. Ann Surg 241:185–193PubMedGoogle Scholar
  2. 2.
    Nissen R (1956) A simple operation for control of reflux esophagitis. Schweiz Med Wochenschr 86(Suppl 20):590–592PubMedGoogle Scholar
  3. 3.
    Collis JL (1957) An operation for hiatus hernia with short esophagus. J Thorac Cardiovasc Surg 14:768–788Google Scholar
  4. 4.
    Skinner DB, Belsey RH (1967) Surgical management of esophageal reflux and hiatal hernia: long-term results with 1030 patients. J Thorac Cardiovasc Surg 53:33–54PubMedGoogle Scholar
  5. 5.
    Johnson AB, Oddsdottir M, Hunter JG (1998) Laparoscopic Collis gastroplasty and Nissen fundoplication: a new technique for the management of esophageal foreshortening. Surg Endosc 12:1055–1060PubMedCrossRefGoogle Scholar
  6. 6.
    Gutt CN, Oniu T, Mehrabi A, Kashfi A, Schemmer P, Buchler MW (2004) Robot-assisted abdominal surgery. Br J Surg 11:1390–1397CrossRefGoogle Scholar
  7. 7.
    Gutt CN, Markus B, Kim ZG, Meininger D, Brinkmann L, Heller K (2002) Early experiences of robotic surgery in children. Surg Endosc 7:1083–1086CrossRefGoogle Scholar
  8. 8.
    Perez A, Zinner MJ, Ashley SW, Brooks DC, Whang EE (2003) What is the value of telerobotic technology in gastrointestinal surgery? Surg Endosc 5:811–813CrossRefGoogle Scholar
  9. 9.
    Weber PA, Merola S, Wasielewski A, Ballantyne GH (2002) Telerobotic-assisted laparoscopic right and sigmoid colectomies for benign disease. Dis Colon Rectum 12:1689–1694CrossRefGoogle Scholar
  10. 10.
    Giulianotti PC, Coratti A, Angelini M, Sbrana F, Cecconi S, Balestracci T, Caravaglios G (2003) Robotics in general surgery: personal experience in a large community hospital. Arch Surg 7:777–784Google Scholar
  11. 11.
    Undre S, Moorthy K, Munz Y, Aggarwal R, Hance J, Rockall T, Darzi A (2004) Robot-assisted laparoscopic Heller cardiomyotomy: preliminary UK results. Dig Surg 5–6:396–400CrossRefGoogle Scholar
  12. 12.
    Morino M, Pellegrino L, Giaccone C, Garrone C, Rebecchi F (2006) Randomized clinical trial of robot-assisted versus laparoscopic Nissen fundoplication. Br J Surg 5:553–558CrossRefGoogle Scholar
  13. 13.
    Hanisch E, Markus B, Gutt C, Schmandra TC, Encke A (2001) Robot-assisted laparoscopic cholecystectomy and fundoplication–initial experiences with the Da Vinci system. Chirurg 3:286–288CrossRefGoogle Scholar
  14. 14.
    Wykypiel H, Wetscher GJ, Klaus A, Schmid T, Gadenstaetter M, Bodner J, Bodner E (2003) Robot-assisted laparoscopic partial posterior fundoplication with the DaVinci system: initial experiences and technical aspects. Langenbecks Arch Surg 11–12:411–416Google Scholar
  15. 15.
    Gutt CN, Bintintan VV, Koninger J, Muller-Stich BP, Reiter M, Buchler MW (2006) Robotic-assisted transhiatal esophagectomy. Langenbecks Arch Surg 391:428–434PubMedCrossRefGoogle Scholar
  16. 16.
    Luketich JD, Raja S, Fernando HC, Campbell W, Christie NA, Buenaventura PO et al (2000) Laparoscopic repair of giant paraesophageal hernia: 100 consecutive cases. Ann Surg 232:608–618PubMedCrossRefGoogle Scholar
  17. 17.
    Pierre AF, Luketich JD, Fernando HC, Christie NA, Buenaventura PO, Litle VR et al (2002) Results of laparoscopic repair of giant paraesophageal hernias: 200 consecutive patients. Ann Thorac Surg 74:1909–1916PubMedCrossRefGoogle Scholar
  18. 18.
    Pitcher DE, Curet MJ, Martin DT, Vogt DM, Mason J, Zucker KA (1995) Successful laparoscopic repair of paraesophageal hernia. Arch Surg 130:590–596PubMedGoogle Scholar
  19. 19.
    Melvin WS, Needleman BJ, Krause KR, Schneider C, Ellison EC (2002) Computer-enhanced vs. standard laparoscopic antireflux surgery. J Gastrointest Surg 1:11–15CrossRefGoogle Scholar
  20. 20.
    Cadière GB, Himpens J, Ertruyen M, Bruyns J, Germay O, Leman G, Izizaw R (2001) Evaluation of telesurgical (robotic) NISSEN fundoplication. Surg Endosc 15:918–923PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag London Ltd 2011

Authors and Affiliations

  • Vladimir Schraibman
    • 1
    • 2
  • Antonio Luiz de Vasconcellos Macedo
    • 1
  • Samuel Okazaki
    • 1
    • 2
  • Fernando Concilio Mauro
    • 1
    • 2
  • Marina Gabrielle Epstein
    • 1
  • Suzan Menasce Goldman
    • 3
  • Suzana Lustosa
    • 1
    • 2
  • Delcio Matos
    • 1
    • 2
  1. 1.Department of General, Gastric and Minimally Invasive SurgeryAlbert Einstein HospitalSão PauloBrazil
  2. 2.Department of Gastric SurgeryFederal University of São PauloSão PauloBrazil
  3. 3.Diagnosis Imaging DepartmentFederal University of Sao Paulo/Escola Paulista de MedicinaSão PauloBrazil

Personalised recommendations