Early operative outcomes and learning curve of robotic assisted giant paraesophageal hernia repair

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 minutes (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.

State-Level Examination of Clinical Outcomes and Costs for Robotic and Laparoscopic Approach to Diaphragmatic Hernia Repair

“…It would undoubtedly be useful to be able to determine the effect of subtype of paraesophageal hernias on outcomes to better identify a subgroup for which robotic assistance is useful. 7 Some of the need for postoperative endoscopy and revisional operations might stem from having recurrent diaphragmatic hernia in our analysis. Repairs of recurrent hernia would be expected to be associated with increased risk of repeat postoperative interventions.…”

“…be that the minimally invasive approaches are associated with increased risk of stricture at the site of the repair, or the increased use of endoscopy might be driven by the fact that the providers performing the minimally invasive approaches to repair are more facile with endoscopy and are routinely performing follow-up endoscopy in their patients. 7,9 The dataset does not provide enough detail about reasons for post-index readmission and intervention to allow for a determination of cause for this disparity. Overall, the rate of post-index hospitalization encounters and rate of endoscopy were relatively low across cohorts with no marked difference in rates between cohorts.…”

“…Proponents of the robotic approach identify the 3-dimensional visualization, favorable surgical ergonomics, and improved instrument maneuverability as having considerable potential to facilitate safe dissection and durable crural repair within the limited confines of the upper abdomen and mediastinum. [6][7][8] Examinations of the effects of robotic-assisted approaches in other general surgical procedures have found equivalent postoperative clinical outcomes when these approaches are compared with standard laparoscopy, but have also consistently identified substantial learning curves, increased operative times, and increased costs associated with the robotic approach. 9,10 To date, the empiric comparisons of robotic-assisted DHR with laparoscopic DHR have been limited.…”

Robotic Versus Laparoscopic Approach to Hiatal Hernia Repair: Results After 7 Years of Robotic Experience

“…5 Similarly, studies of robotic hiatal hernia and fundoplication have found it to be safe with equivalent outcomes to laparoscopy, with no clear improvement in outcomes over the traditional laparoscopic approach. 13,14 Recently however, Solomon et al performed a large review of the Society of Thoracic Surgery database between 2012 and 2017. All repairs were performed at the same institution and it is by far the largest series of its kind, with n = 151 in the laparoscopic arm and n = 142 in the robotic arm.…”

Robotic voluminous paraesophageal hernia repair: a case report and review of the literature

“…Laparoscopic repair is technically difficult in this subset of patients because of the presence of great anatomical distortion, which requires meticulous dissection of the hernia sac that must be accomplished with limited motion of rigid instruments and poor ergonomics [20][21][22]. Furthermore, various reports published in the literature (Table 1) suggest that there is a higher recurrence rate after the laparoscopic approach for giant hiatal hernia (GHH) repair than after conventional surgery [28][29][30]. Andujar et al (2004) [15] analyzed a total of 166 patients with a mean age of 68 years who underwent the laparoscopic approach.…”