title: Robotic-Assisted Paraesophageal Hernia Repair: Initial Experience at a Single Institution.
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.
  
  
  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.
authors.affiliation: Section of Minimally Invasive and Robotic Surgery, Department of Surgery, College of Medicine, University of Arizona , Tucson, Arizona.
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Galvani
authors.affiliation: Section of Minimally Invasive and Robotic Surgery, Department of Surgery, College of Medicine, University of Arizona , Tucson, Arizona.
authors.forename: Hannah
authors.initials: H
authors.lastname: Loebl
authors.affiliation: Section of Minimally Invasive and Robotic Surgery, Department of Surgery, College of Medicine, University of Arizona , Tucson, Arizona.
authors.forename: Obiyo
authors.initials: O
authors.lastname: Osuchukwu
authors.affiliation: Section of Minimally Invasive and Robotic Surgery, Department of Surgery, College of Medicine, University of Arizona , Tucson, Arizona.
authors.forename: Julia
authors.initials: J
authors.lastname: Samamé
authors.affiliation: Section of Minimally Invasive and Robotic Surgery, Department of Surgery, College of Medicine, University of Arizona , Tucson, Arizona.
authors.forename: Matthew E
authors.initials: ME
authors.lastname: Apel
authors.affiliation: Section of Minimally Invasive and Robotic Surgery, Department of Surgery, College of Medicine, University of Arizona , Tucson, Arizona.
authors.forename: Iman
authors.initials: I
authors.lastname: Ghaderi
mesh_terms: D000368:Aged; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006551:Hernia, Hiatal / Q000145:classification / Q000601:surgery*; D059685:Herniorrhaphy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D059032:Learning Curve; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D012008:Recurrence; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000009:adverse effects / Q000379:methods*