Robotic-Assisted Paraesophageal Hernia Repair: Initial Experience at a Single Institution

Carlos A Galvani, Hannah Loebl, Obiyo Osuchukwu, Julia Samamé, Matthew E. Apel, Iman Ghaderi

Research output: Contribution to journalArticle

9 Citations (Scopus)

Abstract

Background: Laparoscopic surgery is considered the standard approach for the treatment of paraesophageal hernias (PEHs). Despite its advantages, this approach is technically demanding with a significant learning curve. Data about the safety and utility of the robotically assisted paraesophageal hernia repair (RA-PEHR) are scarce. The aim of this study is to assess the feasibility and safety of robotic assistance for the treatment of PEH. Materials and Methods: Between June 2010 and December 2015, patients who underwent elective RA-PEHR were included in a prospectively collected database. Demographic data, American Society of Anesthesiologists (ASA) classification, preoperative testing, operative time (OT), length of hospital stay (LOS), conversion rate, morbidity, and mortality were recorded and reviewed retrospectively. Results: Sixty-one patients underwent RA-PEHR with mesh, 72% were female (mean age of 63 and mean body mass index [BMI] of 30). ASA classification was 2.6 (57% of patients had an ASA III). With respect to the type of the hernia, the preoperative diagnosis was: Type II 26%, III 64%, and IV 13%. OT averaged 186 minutes (88-360), including robot setup time. After the 16th case, OT significantly decreased by 4.09 minutes (P = .01). There were no conversions. The average blood loss was 51 mL. Perioperative complications, including intraoperative and 30-day complications, were 6% and 23%, respectively. The mean length of hospitalization was 2.6 (1-18) days. There were no deaths. Forty patients (66%) were available for follow-up, and length of follow-up was 17 ± 15 months. Anatomic recurrence was observed in 42% of patients and only 23% of patients were symptomatic. Conclusions: This report represents the largest series to date of RA-PEHR. RA-PEHR has proved to be feasible and safe with a learning curve comparable to the standard laparoscopic approach.

Original languageEnglish (US)
Pages (from-to)290-295
Number of pages6
JournalJournal of Laparoendoscopic and Advanced Surgical Techniques - Part A
Volume26
Issue number4
DOIs
StatePublished - Apr 1 2016

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Hiatal Hernia
Herniorrhaphy
Robotics
Operative Time
Learning Curve
Length of Stay
Safety
Intraoperative Complications
Hernia
Laparoscopy
Hospitalization
Body Mass Index
Demography
Databases
Morbidity
Recurrence
Mortality
Therapeutics

ASJC Scopus subject areas

  • Surgery

Cite this

Robotic-Assisted Paraesophageal Hernia Repair : Initial Experience at a Single Institution. / Galvani, Carlos A; Loebl, Hannah; Osuchukwu, Obiyo; Samamé, Julia; Apel, Matthew E.; Ghaderi, Iman.

In: Journal of Laparoendoscopic and Advanced Surgical Techniques - Part A, Vol. 26, No. 4, 01.04.2016, p. 290-295.

Research output: Contribution to journalArticle

Galvani, Carlos A ; Loebl, Hannah ; Osuchukwu, Obiyo ; Samamé, Julia ; Apel, Matthew E. ; Ghaderi, Iman. / Robotic-Assisted Paraesophageal Hernia Repair : Initial Experience at a Single Institution. In: Journal of Laparoendoscopic and Advanced Surgical Techniques - Part A. 2016 ; Vol. 26, No. 4. pp. 290-295.
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abstract = "Background: Laparoscopic surgery is considered the standard approach for the treatment of paraesophageal hernias (PEHs). Despite its advantages, this approach is technically demanding with a significant learning curve. Data about the safety and utility of the robotically assisted paraesophageal hernia repair (RA-PEHR) are scarce. The aim of this study is to assess the feasibility and safety of robotic assistance for the treatment of PEH. Materials and Methods: Between June 2010 and December 2015, patients who underwent elective RA-PEHR were included in a prospectively collected database. Demographic data, American Society of Anesthesiologists (ASA) classification, preoperative testing, operative time (OT), length of hospital stay (LOS), conversion rate, morbidity, and mortality were recorded and reviewed retrospectively. Results: Sixty-one patients underwent RA-PEHR with mesh, 72{\%} were female (mean age of 63 and mean body mass index [BMI] of 30). ASA classification was 2.6 (57{\%} of patients had an ASA III). With respect to the type of the hernia, the preoperative diagnosis was: Type II 26{\%}, III 64{\%}, and IV 13{\%}. OT averaged 186 minutes (88-360), including robot setup time. After the 16th case, OT significantly decreased by 4.09 minutes (P = .01). There were no conversions. The average blood loss was 51 mL. Perioperative complications, including intraoperative and 30-day complications, were 6{\%} and 23{\%}, respectively. The mean length of hospitalization was 2.6 (1-18) days. There were no deaths. Forty patients (66{\%}) were available for follow-up, and length of follow-up was 17 ± 15 months. Anatomic recurrence was observed in 42{\%} of patients and only 23{\%} of patients were symptomatic. Conclusions: This report represents the largest series to date of RA-PEHR. RA-PEHR has proved to be feasible and safe with a learning curve comparable to the standard laparoscopic approach.",
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