Robotic-assisted foregut surgery is associated with lower rates of complication and shorter post-operative length of stay.
Fundoplication
Heller
Laparoscopic
Myotomy
Nissen
Robotic
Journal
Surgical endoscopy
ISSN: 1432-2218
Titre abrégé: Surg Endosc
Pays: Germany
ID NLM: 8806653
Informations de publication
Date de publication:
04 2023
04 2023
Historique:
received:
31
03
2022
accepted:
29
11
2022
medline:
11
4
2023
pubmed:
9
12
2022
entrez:
8
12
2022
Statut:
ppublish
Résumé
Two of the most common foregut operations are laparoscopic Heller myotomy and laparoscopic Nissen fundoplication. Robotic assistance, compared to standard laparoscopic approach, may potentially grant surgeons advantages such as enhanced visualization and dexterity. This study compares patient outcomes for Heller myotomy (HM) and Nissen fundoplication (NF) when performed laparoscopically versus robotically. A retrospective review of patients at a single institution who underwent laparoscopic or robotic-assisted HM or NF from January 2019 to July 2022 was conducted. 123 HM (72 laparoscopic, 51 robotic-assisted) and 92 NF (62 laparoscopic, 30 robotic-assisted) were performed by three surgeons. Outcomes investigated were operative time, hospital length of stay, pre- and post-operative imaging, resolution of symptoms at 30 days, resolution of symptoms at 90 days, and complications. In the HM cohorts, the average operative time was longer in the robotic cohort (127 min robotic versus 108 min laparoscopic, p < 0.01). However, overall complication rates (p < 0.05) were lower, and hospital length of stay was shorter in the robotic group (1.5 days compared to 2.7 days, p < 0.001). In the NF cohorts, there was no significant difference in operative time. However, hospital length of stay was shorter in the robotic group (1.54 days compared to 2.7 days, p < 0.001) with otherwise similar outcomes. There was no difference in the rate of post-operative resolution of symptoms or need for additional interventions in either HM or NF. Robotic-assisted HM and NF are associated with shorter hospital stays compared to their respective laparoscopic approaches. Robotic-assisted HM also has a lower rate of complications. Our findings suggest that robotic assistance may be beneficial for shortening hospital length of stay and decreasing complications for certain surgeries specific to Foregut surgery.
Sections du résumé
BACKGROUND
Two of the most common foregut operations are laparoscopic Heller myotomy and laparoscopic Nissen fundoplication. Robotic assistance, compared to standard laparoscopic approach, may potentially grant surgeons advantages such as enhanced visualization and dexterity. This study compares patient outcomes for Heller myotomy (HM) and Nissen fundoplication (NF) when performed laparoscopically versus robotically.
METHODS
A retrospective review of patients at a single institution who underwent laparoscopic or robotic-assisted HM or NF from January 2019 to July 2022 was conducted. 123 HM (72 laparoscopic, 51 robotic-assisted) and 92 NF (62 laparoscopic, 30 robotic-assisted) were performed by three surgeons. Outcomes investigated were operative time, hospital length of stay, pre- and post-operative imaging, resolution of symptoms at 30 days, resolution of symptoms at 90 days, and complications.
RESULTS
In the HM cohorts, the average operative time was longer in the robotic cohort (127 min robotic versus 108 min laparoscopic, p < 0.01). However, overall complication rates (p < 0.05) were lower, and hospital length of stay was shorter in the robotic group (1.5 days compared to 2.7 days, p < 0.001). In the NF cohorts, there was no significant difference in operative time. However, hospital length of stay was shorter in the robotic group (1.54 days compared to 2.7 days, p < 0.001) with otherwise similar outcomes. There was no difference in the rate of post-operative resolution of symptoms or need for additional interventions in either HM or NF.
CONCLUSION
Robotic-assisted HM and NF are associated with shorter hospital stays compared to their respective laparoscopic approaches. Robotic-assisted HM also has a lower rate of complications. Our findings suggest that robotic assistance may be beneficial for shortening hospital length of stay and decreasing complications for certain surgeries specific to Foregut surgery.
Identifiants
pubmed: 36477641
doi: 10.1007/s00464-022-09814-6
pii: 10.1007/s00464-022-09814-6
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2800-2805Informations de copyright
© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.
Références
Galvani C, Gorodner MV, Moser F, Baptista M, Donahue P, Horgan S (2006) Laparoscopic Heller myotomy for achalasia facilitated by robotic assistance. Surg Endosc 20:1105–1112
doi: 10.1007/s00464-005-0272-9
pubmed: 16703438
Galvani CA, Gallo AS, Dylewski MR (2011) Robotic-assisted Heller myotomy for esophageal achalasia: feasibility, technique, and short-term outcomes. J Robot Surg 5:163–166
doi: 10.1007/s11701-011-0255-x
pubmed: 27637702
Markar SR, Karthikesalingam AP, Hagen ME, Talamini M, Horgan S, Wagner OJ (2010) Robotic vs. laparoscopic Nissen fundoplication for gastro-oesophageal reflux disease: systematic review and meta-analysis. Int J Med Robot 6:125–131
pubmed: 20506440
Rodriguez-Sanjuan JC, Gomez-Ruiz M, Trugeda-Carrera S, Manuel-Palazuelos C, Lopez-Useros A, Gomez-Fleitas M (2016) Laparoscopic and robot-assisted laparoscopic digestive surgery: present and future directions. World J Gastroenterol 22:1975–2004
doi: 10.3748/wjg.v22.i6.1975
pubmed: 26877605
pmcid: 4726673
Xie J, Vatsan MS, Gangemi A (2021) Laparoscopic versus robotic-assisted Heller myotomy for the treatment of achalasia: a systematic review with meta-analysis. Int J Med Robot 17:e2253
doi: 10.1002/rcs.2253
pubmed: 33844413
Yao G, Liu K, Fan Y (2014) Robotic Nissen fundoplication for gastroesophageal reflux disease: a meta-analysis of prospective randomized controlled trials. Surg Today 44:1415–1423
doi: 10.1007/s00595-014-0948-7
pubmed: 24909497
Tartaglia N, Pavone G, Di Lascia A, Vovola F, Maddalena F, Fersini A, Pacilli M, Ambrosi A (2020) Robotic voluminous paraesophageal hernia repair: a case report and review of the literature. J Med Case Rep 14:25
doi: 10.1186/s13256-020-2347-6
pubmed: 32019608
pmcid: 6998085
Ali AB, Khan NA, Nguyen DT, Chihara R, Chan EY, Graviss EA, Dunkin BJ, Kim MP (2020) Robotic and per-oral endoscopic myotomy have fewer technical complications compared to laparoscopic Heller myotomy. Surg Endosc 34:3191–3196
doi: 10.1007/s00464-019-07093-2
pubmed: 31482358
Damani T, Ballantyne G (2020) Robotic foregut surgery. Surg Clin North Am 100:249–264
doi: 10.1016/j.suc.2019.11.002
pubmed: 32169179
Milone M, Manigrasso M, Vertaldi S, Velotti N, Aprea G, Maione F, Gennarelli N, De Simone G, De Conno B, Pesce M, Sarnelli G, De Palma GD (2019) Robotic versus laparoscopic approach to treat symptomatic achalasia: systematic review with meta-analysis. Dis Esophagus 32:1–8
doi: 10.1093/dote/doz062
pubmed: 31274153
Cadiere GB, Himpens J, Vertruyen M, Bruyns J, Germay O, Leman G, Izizaw R (2001) Evaluation of telesurgical (robotic) NISSEN fundoplication. Surg Endosc 15:918–923
doi: 10.1007/s004640000217
pubmed: 11605106
Gerull WD, Cho D, Arefanian S, Kushner BS, Awad MM (2021) Favorable peri-operative outcomes observed in paraesophageal hernia repair with robotic approach. Surg Endosc 35:3085–3089
doi: 10.1007/s00464-020-07700-7
pubmed: 32556775
O’Connor SC, Mallard M, Desai SS, Couto F, Gottlieb M, Ewing A, Cobb WS, Carbonell AM, Warren JA (2020) Robotic versus laparoscopic approach to hiatal hernia repair: results after 7 years of robotic experience. Am Surg 86:1083–1087
doi: 10.1177/0003134820943547
pubmed: 32809844
Soliman BG, Nguyen DT, Chan EY, Chihara RK, Meisenbach LM, Graviss EA, Kim MP (2020) Robot-assisted hiatal hernia repair demonstrates favorable short-term outcomes compared to laparoscopic hiatal hernia repair. Surg Endosc 34:2495–2502
doi: 10.1007/s00464-019-07055-8
pubmed: 31385076
Lang F, Huber A, Kowalewski KF, Kenngott HG, Billmann F, Billeter AT, Fischer L, Bintintan VV, Gutt CN, Muller-Stich BP, Nickel F (2022) Randomized controlled trial of robotic-assisted versus conventional laparoscopic fundoplication: 12 years follow-up. Surg Endosc 36:5627–5634
doi: 10.1007/s00464-021-08969-y
pubmed: 35076737
pmcid: 9283162