Intraoperative and postoperative outcome of robot-assisted and traditional laparoscopic Nissen fundoplication.
BACKGROUND
Robotics has been proposed as a tool to improve laparoscopic Nissen fundoplication. However, a clear benefit of this technology for minimally invasive antireflux surgery has not been demonstrated.


METHODS
A retrospective review of a prospective database was used to compare the intraoperative and postoperative outcome of 137 patients who underwent conventional laparoscopic fundoplication (CLF) and 45 patients who underwent laparoscopic robot-assisted fundoplication (LRF). Intraoperative outcome measures were: operative time, blood loss and complications. Length of hospital stay, functional results and patient satisfaction were used to compare postoperative outcome.


RESULTS
Operative time was significantly shorter in the LRF group (65 min) compared to the CLF group (85 min) (p < 0.0001). The overall complication rate was comparable between the two techniques, even though a higher incidence of liver tears was encountered in the CLF group (p < 0.05). Hospital stay, symptom relief and patient satisfaction did not differ between the groups.


CONCLUSIONS
Robotics improves surgeon dexterity and maneuverability during laparoscopic Nissen fundoplication, but this does not correspond to a better postoperative outcome. LRF should be used only for complex cases and training.
Ceccarelli
G
G
Department of General, Vascular, Minimally Invasive and Robotic Surgery, San Matteo degli Infermi Hospital, ASL 3 dell'Umbria, Spoleto, Italy. g.cecca2003@libero.it
Patriti
A
A
Biancafarina
A
A
Spaziani
A
A
Bartoli
A
A
Bellochi
R
R
Casciola
L
L
D000328:Adult; D000368:Aged; D016208:Databases, Factual; D005260:Female; D018662:Fundoplication / Q000009:adverse effects / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000601:surgery; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology; D007432:Intraoperative Period; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D012189:Retrospective Studies; D012371:Robotics / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D020535:Video-Assisted Surgery / Q000009:adverse effects / Q000379:methods