Abstract
Background
A new technical tool was developed and introduced into the therapeutic field of videoscopic surgery—robotic telemanipulation surgery. The aim of this study is to investigate in a prospective randomized trial the feasibility of the Nissen procedure using the da Vinci and to evaluate the benefits and the costs of this new technique compared with the conventional laparoscopic approach.
Materials and methods
Twenty patients with gastro-esophageal reflux disease (GERD) were randomized into laparoscopic Nissen versus robot-assisted Nissen fundoplication. All the patients signed an informed consent document. The time data of the procedure, the efficacy of the instruments, the intra-operative incidents, postoperative morbidity, and cost minimization are presented.
Results
Nine patients were assigned to the robot, and 11 to the laparoscopic procedure. Both groups were similar in age, male/female ratio, and body mass index. The robot procedure time was significantly longer. The hospital stay and the alimentation day were similar. The number of postoperative complaints was similar after the 1st, 6th, and 12th postoperative months. However, on the 3rd postoperative month, the number of complaints was significantly higher in the robot group. The robot procedure was more expensive with regard to the instrumentation and reusable material, the nursing costs, the investment costs, and the maintenance costs.
Conclusions
No clear advantage of using robotics in the Nissen procedure was observed. The procedure seems to be feasible and safe. The technique is limited because of unadapted instruments. The disadvantages are the high costs and prolonged operative time.
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References
Schurr MO, Breitwieser H, Melzer A, et al. Experimental telemanipulation in endoscopic surgery. Surg Laparosc 1996;6:167–175
Berguer R, Rab GT, Abu-Ghaida H, et al. A comparison of surgeons’ posture during laparoscopic and open surgical procedures. Surg Endosc 1997;11:139–142
Meir AH, Rawn CL, Krummel TM. Virtual reality: surgical application—challenge for the new millennium. J Am Coll Surg 2001;192:372–384
Mélot C. Economic evaluation in health care. In: Szpalski M, Gunzburg R (editors). Lumbar spinal stenosis. Philadelphia Williams & Wilkins 1999, pp 357–365
Besley S, Brigham EF. Essentials of managerial finance. 12th edition. Philadelphia, Dryden press, 2000, pp 340–343
Dubois F, Berthelot G, Levard H. Cholecystectomy with celioscopy: 330 cases. Chirurgie 1990;116:248–250
Dion YM, Gaillard F. Visual integration of data and basic motor skills under laparoscopy: influence of 2-D and 3-D video-camera systems. Surg Endosc 1997;11:995–1000
Cadiere GB, Himpens J, Vertruyen M, et al. Nissen fundoplication done by remotely controlled robotic technique. Ann Chir 1999;53:137–141
Voorhorst FA, Overbeeke CJ, Smets GJ. Spatial perception during laparoscopy: implementing action-perception coupling. Stud Health Technol Inform 1997;39:379–386
Cadiere GB, Himpens J, Vertruyen M, et al. Evaluation of telesurgical (robotic) Nissen fundoplication. Surg Endosc 2001;15:918–923
McDougall EM, Soble JJ, Wolf JS Jr, et al. Comparison of three-dimensional and two-dimensional laparoscopic video systems. J Endourol 1996;10:371–374
Garcia-Ruiz A, Gagner M, Miller JH, et al. Manual versus robotically assisted laparoscopic surgery in the performance of basic manipulation and suturing tasks. Arch Surg 1998;133:957–961
Margossian H, Garcia-Ruiz A, Falcone T, et al. Robotically assisted laparoscopic microsurgical uterine horn Anastomosis Fertil Steril 1998;70:530–534
Urban V, Wappler M, Weisener T, et al. A tactile feedback hexapod operating robot for endoscopic procedures. Neurol Res 1996;21:28–30
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Nakadi, I.E., Mélot, C., Closset, J. et al. Evaluation of da Vinci Nissen Fundoplication Clinical Results and Cost Minimization. World J. Surg. 30, 1050–1054 (2006). https://doi.org/10.1007/s00268-005-7950-6
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DOI: https://doi.org/10.1007/s00268-005-7950-6