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Robot-assisted gastroesophageal surgery: usefulness and limitations

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Abstract

Robot-assisted surgery overcomes some of the limitations of traditional laparoscopic surgery. We present our experience and lessons learned in two surgical units dedicated to gastro-esophageal surgery. From June 2009 to January 2013, we performed 130 robot-assisted gastroesophageal procedures, including Nissen fundoplication (29), paraesophageal hernia repair (18), redo for failed antireflux surgery (11), esophagectomy (19), subtotal (5) or wedge (4) gastrectomy, Heller myotomy for achalasia (22), gastric bypass for morbid obesity (12), thoracoscopic leiomyomectomy (4), Morgagni hernia repair (3), lower-third esophageal diverticulectomy (1) and two diagnostic procedures. There were 80 men and 50 women with a median age of 54 years (interquartile range: 46–65). Ten patients (7.7 %) had severe postoperative complications: eight after esophagectomy (three leaks—two cervical and one thoracic—managed conservatively), one stapler failure, one chylothorax, one case of gastric migration to the thorax, one case of biliary peritonitis, and one patient with a transient ventricular dyskinesia. One redo procedure needed reoperation because of port-site bleeding, and one patient died of pulmonary complications after a giant paraesophageal hernia repair; 30-day mortality was, therefore, 0.8 %. There were six elective and one forced conversions (hemorrhage), so total conversion was 5.4 %. Median length of stay was 4 days (IQ range 3–7). Robot-assisted gastroesophageal surgery is feasible and safe, and may be applied to most common procedures. It seems of particular value for Heller myotomy, large paraesophageal hernias, redo antireflux surgery, transhiatal dissection, and hand-sewn intrathoracic anastomosis.

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Acknowledgments

We have to thank Dr Peter McCulloch, from the Center for Evidence-based Medicine (Oxford, UK), for his critical review of the Manuscript.

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Authors and Affiliations

  1. Esophago-gastric Surgery and Robotic Unit, Service of General and Digestive Surgery, Basurto University Hospital, Avenida Montevideo, 18, 48013, Bilbao, Spain

    Ismael Diez del Val, Carlos Loureiro Gonzalez, Julen Barrenetxea Asua & Jose Esteban Bilbao Axpe

  2. Esophago-gastric Surgery Unit, Service of General and Digestive Surgery, Araba University Hospital, Jose Achotegui, s/n, 01009, Vitoria-Gasteiz, Spain

    Cándido Martinez Blazquez, Jose Maria Vitores Lopez & Valentin Sierra Esteban

  3. Service of General and Digestive Surgery, Basurto University Hospital, Avenida Montevideo, 18, 48013, Bilbao, Spain

    Izaskun del Hoyo Aretxabala, Patricia Perez de Villarreal & Jaime Jesus Mendez Martin

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  1. Ismael Diez del Val
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  2. Cándido Martinez Blazquez
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Correspondence to Ismael Diez del Val.

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Diez del Val, I., Martinez Blazquez, C., Loureiro Gonzalez, C. et al. Robot-assisted gastroesophageal surgery: usefulness and limitations. J Robotic Surg 8, 111–118 (2014). https://doi.org/10.1007/s11701-013-0435-y

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  • DOI: https://doi.org/10.1007/s11701-013-0435-y

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