Robotic Foregut Surgery: One Surgeon’s Experience with Nissen Fundoplication, Esophagomyotomy, and Hiatal Hernia Repair

Purpose: The purpose of the study was to review a single surgeon, seven-year experience, using the Da Vinci Telerobotic system performing 124 foregut operations. Methods: Data review from 2002-2009 including 71 Nissen fundoplications, 26 esophagomyotomies, and 27 hiatal hernia repairs was performed. Parameters collected included gender, age, body mass index (BMI), estimated blood loss (EBL), port set up time (PST), robot operating time (ROT), total case time (TCT), length of stay (LOS), complications, conversions, and resident involvement. Statistical analysis was conducted. Results: 124 foregut operations: 45 males, 79 females, mean age of 54.8 ± 16.7 (18 85) years, mean TCT 174.4 ± 45.0 (102 321) min. Nissen fundoplication: mean BMI of 30.8 ± 3.9 (22.4 46.8) kg/m, EBL 30.2 ± 21.8 (5 100) ml, PST 32.3 ± 9 (14 63) min, ROT 111.4 ± 37.3 (51 229) min, TCT 175.0 ± 46.4 (102 321) min, median LOS 1 (0 9) day, complication rate 7.0% (5/71), conversion rate 5.6%, resident involvement 69.0% (49/71). Esophagomyotomy: mean BMI of 26.5 ± 6.1 (15.4 36.6) kg/m, EBL 39.1 ± 41.7 (10 200) ml, PST 28.0 ± 8.6 (16 47) min, ROT 122.9 ± 45 (31 217) min, and TCT 178.0 ± 40.5 (105 262) min, median LOS 1 (0 6) day, complication rate 15.4% (4/26), conversion rate 0%, resident involvement 69.2% (18/26). Hiatal hernia repair: mean BMI of 28.4 ± 4.2 (21.9 36.8) kg/m, EBL 38.4 ± 32.7 (10 150) ml, PST 28.8 ± 8.0 (17 52) min, ROT 109.0 ± 44.5 (49 250) min, and TCT 169.2 ± 46.5 (102 299) min, median LOS 1 (1 14) day, complication rate 11.1% (3/27), conversion rate 3.7%, resident involvement 66.7% (18/27). Conclusion: Robotic-assisted foregut surgery is safe and effective. This series compares favorably with other robotic studies in length of hospital stay, total case time, and complication and conversion rates. Foregut surgery is an excellent robotic training ground for residents.