Laparoscopic versus robot-assisted Nissen fundoplication in an infant pig model.
OBJECTIVE
Surgical robots are designed to facilitate dissection and suturing, although objective data on their superiority are lacking. This study compares conventional laparoscopic Nissen fundoplication (CLNF) to robot-assisted Nissen fundoplication (RANF) using computer-based workflow analysis in an infant pig model.


METHODS
CLNF and RANF were performed in 12 pigs. Surgical workflow was segmented into phases. Time required to perform specific actions was compared by t test. The quality of knot-tying was evaluated by a skill scoring system. Cardia yield pressure (CYP) was determined to test the efficacy of the fundoplications, and the incidence of complications was compared.


RESULTS
There was no difference in average times to complete the various phases, despite faster robotic knot-tying (p = 0.001). Suturing quality was superior in CLNF (p = 0.02). CYP increased similarly in both groups. Workflow-interrupting hemorrhage and pneumothorax occurred more frequently during CLNF (p = 0.040 and 0.044, respectively), while more sutures broke during RANF (p = 0.001).


CONCLUSIONS
The robot provides no clear temporal advantage compared to conventional laparoscopy for fundoplication, although suturing was faster in RANF. Fewer complications were noted using the robot. RANF and CLNF were equally efficient anti-reflux procedures. For robotic surgery to manifest its full potential, more complex operations may have to be evaluated.
Department of Pediatric Surgery, University of Leipzig, Leipzig, Germany.
Alexandra
A
Krauss
Thomas
T
Neumuth
Robin
R
Wachowiak
Bernd
B
Donaubauer
Werner
W
Korb
Oliver
O
Burgert
Oliver J
OJ
Muensterer
D000818:Animals; D018662:Fundoplication / Q000379:methods*; D010535:Laparoscopy; D023421:Models, Animal; D012371:Robotics; D034421:Sus scrofa