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Robotic-assisted paraesophageal hernia repair—a case–control study

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Abstract

Aims

The da Vinci® telemanipulation system offers a wide range of precise movements and 3D visualization with depth perception and magnification effect. Such a system could be useful for improving minimally invasive procedures—as in the case of large hiatal hernia with paraesophageal involvement (PEH) repair. Studies reporting on the robotic-assisted PEH repair are scarce, and a comparison to the standard operation techniques is lacking. Therefore, we decided to investigate the feasibility and safety of robotic-assisted surgery (RAS) compared to conventional laparoscopic (CLS) and open surgery (OS) for the first time.

Methods

We investigated 42 patients for the perioperative outcome after PEH repair. Twelve patients were operated on with RAS, 17 with CLS, and 13 with OS. Operating time, intraoperative blood loss, intra- and postoperative complications, mortality, and duration of hospital stay were analyzed in each method.

Results

On average, operating time in the RAS group was 38 min longer, and the intraoperative blood was loss 217 ml lower compared to OS. Both results were similar to the CLS group. The intraoperative complication rate was similar in all groups. The postoperative complication rate in the RAS group was significantly lower than the OS group, though again similar to the CLS group. The hospital stay was 5 days shorter in the RAS group than the OS group and once again similar to the CLS group.

Conclusion

The results show that RAS is feasible and safe. It appears to be an alternative to OS due to lower intraoperative blood loss and potentially fewer postoperative complications, as well as shorter hospital stay. Though, RAS is not superior to CLS.

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Conflicts of interest

The authors T. Gehrig, A. Mehrabi, L. Fischer, H. Kenngott, U. Hinz, C. N. Gutt, B. P. Müller-Stich declare that they have no competing interests, financial or otherwise. No external funds were used to perform the evaluation, and all of the technology tested was separately purchased to complete the study. In addition, the authors had full control of the design of the study, methods used, outcome measurements, analysis of data, and production of the written report.

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Authors and Affiliations

  1. Department of General, Visceral and Transplant Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany

    Tobias Gehrig, A. Mehrabi, L. Fischer, H. Kenngott, U. Hinz, C. N. Gutt & Beat P. Müller-Stich

  2. Department of General, Visceral, Vascular and Thoracic Surgery, Memmingen Hospital, Memmingen, Germany

    C. N. Gutt

Authors
  1. Tobias Gehrig
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  2. A. Mehrabi
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  3. L. Fischer
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  4. H. Kenngott
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  5. U. Hinz
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  6. C. N. Gutt
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  7. Beat P. Müller-Stich
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Corresponding author

Correspondence to Beat P. Müller-Stich.

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Gehrig, T., Mehrabi, A., Fischer, L. et al. Robotic-assisted paraesophageal hernia repair—a case–control study. Langenbecks Arch Surg 398, 691–696 (2013). https://doi.org/10.1007/s00423-012-0982-0

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  • DOI: https://doi.org/10.1007/s00423-012-0982-0

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