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

Abstract

Introduction Robotic hiatal hernia repair offers potential advantages over traditional laparoscopy, most notably enhanced visualization, improved ergonomics, and articulating instruments. The clinical outcomes, however, have not been adequately evaluated. We report outcomes of laparoscopic and robotic hiatal hernia repairs. Methods A retrospective observational cohort study was performed of all hiatal hernia repairs performed from 2006 through 2019. Operative, demographic, and outcomes data were compared between laparoscopic and robotic groups. Discrete variables were analyzed with Chi-square of Fisher’s exact test. Continuous variables were analyzed with Student’s t test (mean) or Wilcoxon rank sum (medians). All analyses were performed using R statistical software. Results Laparoscopic repair was performed in 278 patients and robotic repair in 114. More recurrent hernias were repaired robotically (24.5% vs 12.9%, P = .08). Operative times were no different between groups (175 vs 179 minutes; P = .681). Robotic repair resulted in significantly shorter length of stay (LOS; 2.3 vs 3.3 days; P = .003). Rate of readmission was no different, and there were no differences in acute complications. For patients with at least 1 year of follow-up, recurrence rates were lower after robotic repair (13.3% vs 32.8%; P = .008); however, mean follow-up is significantly longer after laparoscopic repair (23.7 ± 28.4 vs 15.1 ± 14.9 months; P < .001). Discussion Robotic hiatal hernia repair offers technical advantages over laparoscopic repair with similar clinical outcomes.

Laparoscopic transabdominal preperitoneal repair (umbilical TAPP) versus open ventral patch repair for medium size umbilical hernias in overweight and obese patients.

“…TAPP umbilical surgery now commonly involves the use of surgical robots that make this procedure much easier. First, they allow for very good visualization of all prepared layers while maintaining continuous hemostasis, minimizing hand tremors and excessive movements, prevent damage to the thin peritoneal lamina, and after preparing the appropriate space they allow for quick, reliable, and convenient closure of the hernia and peritoneal defects [17]. For these reasons, many surgeons believe that this is an operation that should only be performed in centers equipped with robotic systems [18].…”

Impact of Robotic Approach on Post-Anastomotic Leaks After Esophagectomy for Esophageal Cancer

“…Studies have shown robotic approach to gastrointestinal surgery provides enhanced visualization, more precise dissection of tissue planes, and better articulation of instruments. 11,12 In particular, specific advantages robotic surgery provides for foregut surgery include better tissue manipulation for creating intracorporeal anastomosis and longer instruments allowing easier dissection in the mediastinum. Factors regarding location of anastomosis and type of anastomosis created may also explain the occult nature of anastomotic leaks observed after robotic esophagectomies.…”

Treatment of Giant Esophageal Epiphrenic Diverticulum Using Robotic-Assisted Surgery

“… 4 , 10 It is crucial to perform partial fundoplication to avoid reflux disease, protecting the esophageal mucosa from possible complications. 12 – 15 …”

“…4,10 It is crucial to perform partial fundoplication to avoid reflux disease, protecting the esophageal mucosa from possible complications. [12][13][14][15] The main complications of surgical treatment are empyema, abscesses, and fistulas; which must be quickly identified and treated. In addition, failure to perform esophageal myotomy may result in a high-pressure zone of the staple line of the resected diverticulum, causing it to rupture.…”