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OBJECTIVE- Data on Robotic Paraesophageal Hernia Surgery is scarce in the current literature. The objective of this study is to evaluate the efficacy and short-term outcomes of Robotic-Assisted Surgery for Paraesophageal hernias using the da Vinci telemanipulation system.
DESIGN- Retrospective cohort study with average follow up of 9 months
SETTING- Large Community Hospital
PATIENTS- 29 consecutive patients with Paraesophageal Hernia who underwent Robotic- Assisted Repair between February 2011 and March 2013 were included in the study. The mean age of the patients was 68.7 years (SD=16.7), 82% were female and the mean Body Mass Index(BMI) was 29 (SD=6.3). The procedure was aborted in 1 patient (3.4%) due to cardiac arrest at the start of procedure and the outcomes were analysed in the rest of 28 patients.
INTERVENTION- All patients underwent reduction of hernia contents, dissection of sac and esophageal mobilization followed by crural approximation with Ethibond sutures. Nissen fundoplication was performed in 16 patients (57%) and gastrostomy was performed in 8 patients (28%). In 19 patients (68%), the crural repair was reinforced with a biologic mesh.
MAIN OUTCOME MEASURES- Operative time, Intra-operative and Post operative complications, Conversion, Mortality and Length of hospital stay.
RESULTS- Mean operative time, including the robot docking time was 83.6 min(SD=24). The average length of hospital stay was 2.8 days (SD=1.9). There were no conversions. Transient post operative dysphagia was noted in 3 patients (10.7%). There was one death (3.5%), one patient required readmission for esophageal dilation and one symptomatic recurrence was noted at 8 months (3.5% recurrence).
CONCLUSIONS- Robotic paraesophageal hernia repair can be safely performed with minimum complications even in older patients with high operative risks.