Robotic fundoplication in children

Abstract

Since January 2006, robotic assistance has been used for performing minimal invasive laparoscopic fundoplications in children. These patients were compared with those operated on with either the open surgical technique or the laparoscopic procedure. The first six children operated on with a fundoplication using the operation robot, da Vinci® Surgical System from Intuitive Surgical®, were included prospectively. As controls, data from the latest six children operated on using the open surgical procedure and the latest six children operated on using the minimal invasive laparoscopic technique were selected retrospectively. All the patients were operated on due to gastroesophageal reflux and were comparable in the De Meester score. The main outcome measures were the operating time, the use of postoperative analgesics, the duration of the postoperative hospital stay and the short-term outcome. There was no significant difference between the three groups concerning age, body weight and preoperative 24 h pH measurement. The mean operating time for the robotic group, 213 min, was the longer one, but the operating time for the latest four patients in the robotic group was similar to that for the laparoscopic group, 189 min. The postoperative hospital stay was shorter and a reduction in the use of analgesics postoperatively was noted. The reduction in the postoperative hospital stay and in the use of analgesics had been already noted with the introduction of the minimal invasive laparoscopic technique. There was no difference in short-term clinical outcome; the gastroesophageal reflux symptoms disappeared in all the patients. Robot-assisted laparoscopic fundoplication is comparable with the standard laparoscopic surgical procedure in terms of duration of operation, postoperative hospital stay, use of postoperative analgesics and short-term clinical outcome. The robotic surgery adds qualities to the surgical work when compared with open or laparoscopic surgery. These include better visualisation for the surgeon and greater precision in the movements of the instruments used.

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Acknowledgments

Acknowledge to Håkan Lövkvist MSC, biostatistician, Competence Centre for Clinical Research, University Hospital, SE-221 85 LUND, Sweden, for statistical advice and Gillian Sjödahl, Lexis English for Writers, Persikevägen 11, 22355 Lund Sweden, for linguistic revision of the manuscript. This study was financially supported by Crafoordska stiftelsen, Box 137, 221 00 Lund, Sweden, Stiftelsen Samariten, Sachsska Children’s Hospital, 118 83 Stockholm, Sweden and The Skåne Region Research and Development Foundation, Box 1, 221 00 Lund, Sweden. This report complies with the current laws in the country in which it is written.

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Correspondence to Magnus Anderberg.

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Anderberg, M., Kockum, C.C. & Arnbjörnsson, E. Robotic fundoplication in children. Pediatr Surg Int 23, 123–127 (2007). https://doi.org/10.1007/s00383-006-1817-2

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Keywords

  • Robotic surgery
  • Fundoplication
  • Children
  • da Vinci® Surgical System
  • Laparoscopy
  • Robot
  • Paediatric surgery