Laparoscopic Morgagni hernia repair in children using robotic instruments.
BACKGROUND
Robotic surgery enhances minimally invasive surgery through tremor filtration, motion scaling, indexed movement, articulation, and improved ergonomics. We report 2 cases of computer- assisted, robot-enhanced, laparoscopic repair of Morgagni hernia in a 23-month-old weighing 10.2 kg and a 5-year-old weighing 21.6 kg.


METHODS
Four 5 mm trocars were used to gain access to the abdomen. In the first case, standard laparoscopic instruments were used to dissect the liver from the rim of the defect and then reduce the hernia. In the second, robotic instruments were used for this dissection. In both cases, the robot- enhanced instruments were used to close the hernia defects with interrupted, nonabsorbable suture, using intracorporeal knot tying.


RESULTS
Both cases were completed laparoscopically without a patch. The robotic system took 9 minutes to set up and drape. The average operative time was 227 minutes. The older child tolerated oral intake the day of surgery and went home the following day. The younger child tolerated oral intake and went home on postoperative day 2.


CONCLUSIONS
Robot-assisted laparoscopic Morgagni hernia repair is feasible.
Knight
Colin G
CG
The Maxine and Stuart Frankel Foundation Computer-Assisted Robot-Enhanced Surgery Program at Children's Hospital of Michigan, Detroit, Michigan 48201, USA. knight_colin@yahoo.com
Gidell
Kelly M
KM
Lanning
David
D
Lorincz
Attila
A
Langenburg
Scott E
SE
Klein
Michael D
MD
D002675:Child, Preschool; D006548:Hernia, Diaphragmatic / Q000601:surgery*; D065630:Hernias, Diaphragmatic, Congenital; D006801:Humans; D007223:Infant; D010535:Laparoscopy; D008297:Male; D012371:Robotics