Robot‐assisted oesophageal and gastric surgery for benign disease: antireflux operations and <scp>H</scp>eller's myotomy

Falkenback, Dan; Lehane, Christopher; Lord, Reginald V.

doi:10.1111/ans.12731

Cited by 29 publications

(21 citation statements)

References 55 publications

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“…Interestingly, the robotic group also had a slight improvement in perioperative outcomes, though this occurred with the price of some increased costs. Moreover, a recent, very comprehensive review 23 of LM vs RM, including six RCTs (of poor quality) showed similar outcomes for the two methods, and an increased cost for the robotic technique.…”

Section: Esophagusmentioning

confidence: 99%

Gastrointestinal robotic surgery: challenges and developments

Becchini¹,

Annecchiarico²,

Marino³

et al. 2015

RSRR

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Abstract:The rapid diffusion of new technologies in surgery, together with high expectations of both patients and the mass media, has led to many gastrointestinal procedures being approached using robots. Robotic technology seems to resolve many of the drawbacks of laparoscopic advanced procedures, such as anastomotic reconstructions, accurate lymphadenectomy, and vascular sutures. In addition, a deeper tridimensional steady vision with excellent high definition, the EndoWrist technology offering seven degrees of freedom, tremor filtration, scaled motion, optimal working ergonomics, and avoidance of the 'fulcrum effect', are the main strengths of the da Vinci ® system. The use of near-infrared technology and the possibility of tutoring through a double-console will most likely add many more advantages of this technology over laparoscopy alone. However, none of the gastrointestinal robotic interventions has reached a level of evidence-based efficacy that enables it to be routinely applied. The main limitations of robotic gastrointestinal procedures are represented by the learning curve, the higher costs of robotic surgery compared to traditional and laparoscopic surgery, and the longer operation times, including setup and organizational troubles. Moreover, while the limits of robotics for benign diseases are mainly represented by technical issues, oncologic outcomes remain the foundation of any procedures to cure malignancies, and long-term follow-up is still lacking. On the other hand, a word of caution should be presented on the adoption of robotics in too many surgical units without the correct and formal technical background and third-party control to guarantee the best outcomes for patients at minimum risk. Therefore, the robotic treatment of gastrointestinal diseases requires a thorough analysis of the published evidence, in order to determine the correct indications and patient selection. This review aims to examine the evidence for the use of robotic surgery in both malignancies and benign disease arising from the gastrointestinal area. Future developments in robotics and ongoing areas of research are also analyzed.

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Section: Esophagusmentioning

confidence: 99%

Gastrointestinal robotic surgery: challenges and developments

Becchini¹,

Annecchiarico²,

Marino³

et al. 2015

RSRR

View full text Add to dashboard Cite

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“…Since 2001, 35 papers have been published on robotic-assistance in hiatal hernia and antireflux surgery. Among these papers were 10 literature reviews [9,[32][33][34][35][36][37][38][39][40], complemented with a meta-analysis in four [33,34,38,40]. These reviews described up to five randomized controlled trials [10,[41][42][43][44], 17 cohorts, case-control studies, or caseseries [11,[45][46][47][48][49][50][51][52][53][54][55][56][57][58][59][60].…”

Section: Robot-assisted Antireflux Surgery; Review Of Literaturementioning

confidence: 99%

“…In comparing robot-assisted laparoscopic hiatal hernia and antireflux surgery to conventional laparoscopic surgery, most studies report no difference in post-operative outcome [10,36,41,43,50,51], complication rate [33,35,36,48,58], or conversion rate [33,36,48]. Nor is there is difference in quality of life [10,43,44,51], duration of hospital stay [10,11,35,38,40,48,51] or post-operative morbidity [11,42,45,48].…”

Section: Robot-assisted Antireflux Surgery; Review Of Literaturementioning

confidence: 99%

“…Common concerns with the use of robotic assistance are the duration of surgery and its associated cost. Several studies reported longer total OR times for robotic surgery [10,35,36,41,42,44,45,48,51,54], others report robotic surgery to be quicker [50,61], or show no significant difference [34,35,38,58]. Longer OR times could either be explained by difference in duration of setting up and docking of the robot in combination with the manner of reporting the OR times (total or incision-to-closure) [35,38,41,44,50,58].…”

Section: Robot-assisted Antireflux Surgery; Review Of Literaturementioning

confidence: 99%

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Robot‐assisted laparoscopic hiatal hernia and antireflux surgery

Tolboom

Broeders

Draaisma

2015

Journal of Surgical Oncology

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Gastroesophageal reflux disease is a common disorder of the GE-junction that allows gastric acid to enter the esophagus. Surgery is indicated when the presence of the disease is objectively documented. The laparoscopic Toupet fundoplication is the preferred treatment of GERD. There is no clear advantage in robotic assistance for primary antireflux surgery. In our center we find the robot to be of added value for redo surgery or large and giant hiatal repair.

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“…It offers several potential technical improvements, such as the three-dimensional visualization of the operating field, increased movement accuracy and precision secondary to the enhanced maneuverability of the surgical tools, and better surgeon ergonomics. To date, several studies have been conducted aiming to assess the benefits and the limitations of this technology for esophageal diseases (1)(2)(3)(4).…”

Section: Introductionmentioning

confidence: 99%

Robotic technological aids in esophageal surgery

2017

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Robotic technology is an emerging technology that has been developed in order to overcome some limitations of the standard laparoscopic approach, offering a stereoscopic three-dimensional visualization of the surgical field, increased maneuverability of the surgical tools with consequent increased movement accuracy and precision and improved ergonomics. It has been used for the surgical treatment of most benign esophageal disorders. More recently, it has been proposed also for patients with operable esophageal cancer. The current evidence shows that there are no real benefits of the robotic technology over conventional laparoscopy in patients undergoing a fundoplication for gastroesophageal reflux disease (GERD), hiatal closure for giant hiatal hernia, or Heller myotomy for achalasia. A few small studies suggest potential advantages in patients undergoing redo surgery for failed fundoplication or Heller myotomy, but large comparative studies are needed to better clarify the role of the robotic technology in these patients.Robot-assisted esophagectomy seems to be safe and effective in selected patients; however, there are no data showing superiority of this approach over both conventional laparoscopic and open surgery. The short-term and long-term oncologic results of ongoing randomized controlled trials (RCTs) are awaited to validate this approach for the treatment of esophageal cancer.

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Robot‐assisted oesophageal and gastric surgery for benign disease: antireflux operations and Heller's myotomy

Cited by 29 publications

References 55 publications

Gastrointestinal robotic surgery: challenges and developments

Gastrointestinal robotic surgery: challenges and developments

Robot‐assisted laparoscopic hiatal hernia and antireflux surgery

Robotic technological aids in esophageal surgery

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