title: Robot-assisted gastroesophageal surgery: usefulness and limitations.
abstract: Robot-assisted surgery overcomes some of the limitations of traditional laparoscopic surgery. We present our experience and lessons learned in two surgical units dedicated to gastro-esophageal surgery. From June 2009 to January 2013, we performed 130 robot-assisted gastroesophageal procedures, including Nissen fundoplication (29), paraesophageal hernia repair (18), redo for failed antireflux surgery (11), esophagectomy (19), subtotal (5) or wedge (4) gastrectomy, Heller myotomy for achalasia (22), gastric bypass for morbid obesity (12), thoracoscopic leiomyomectomy (4), Morgagni hernia repair (3), lower-third esophageal diverticulectomy (1) and two diagnostic procedures. There were 80 men and 50 women with a median age of 54 years (interquartile range: 46-65). Ten patients (7.7 %) had severe postoperative complications: eight after esophagectomy (three leaks-two cervical and one thoracic-managed conservatively), one stapler failure, one chylothorax, one case of gastric migration to the thorax, one case of biliary peritonitis, and one patient with a transient ventricular dyskinesia. One redo procedure needed reoperation because of port-site bleeding, and one patient died of pulmonary complications after a giant paraesophageal hernia repair; 30-day mortality was, therefore, 0.8 %. There were six elective and one forced conversions (hemorrhage), so total conversion was 5.4 %. Median length of stay was 4 days (IQ range 3-7). Robot-assisted gastroesophageal surgery is feasible and safe, and may be applied to most common procedures. It seems of particular value for Heller myotomy, large paraesophageal hernias, redo antireflux surgery, transhiatal dissection, and hand-sewn intrathoracic anastomosis.
authors.affiliation: Esophago-gastric Surgery and Robotic Unit, Service of General and Digestive Surgery, Basurto University Hospital, Avenida Montevideo, 18, 48013, Bilbao, Spain. ismael.diezdelval@osakidetza.net.
authors.forename: Ismael
authors.initials: I
authors.lastname: Diez Del Val
authors.affiliation: Esophago-gastric Surgery Unit, Service of General and Digestive Surgery, Araba University Hospital, Jose Achotegui, s/n, 01009, Vitoria-Gasteiz, Spain.
authors.forename: Cándido
authors.initials: C
authors.lastname: Martinez Blazquez
authors.affiliation: Esophago-gastric Surgery and Robotic Unit, Service of General and Digestive Surgery, Basurto University Hospital, Avenida Montevideo, 18, 48013, Bilbao, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Loureiro Gonzalez
authors.affiliation: Esophago-gastric Surgery Unit, Service of General and Digestive Surgery, Araba University Hospital, Jose Achotegui, s/n, 01009, Vitoria-Gasteiz, Spain.
authors.forename: Jose Maria
authors.initials: JM
authors.lastname: Vitores Lopez
authors.affiliation: Esophago-gastric Surgery Unit, Service of General and Digestive Surgery, Araba University Hospital, Jose Achotegui, s/n, 01009, Vitoria-Gasteiz, Spain.
authors.forename: Valentin
authors.initials: V
authors.lastname: Sierra Esteban
authors.affiliation: Esophago-gastric Surgery and Robotic Unit, Service of General and Digestive Surgery, Basurto University Hospital, Avenida Montevideo, 18, 48013, Bilbao, Spain.
authors.forename: Julen
authors.initials: J
authors.lastname: Barrenetxea Asua
authors.affiliation: Service of General and Digestive Surgery, Basurto University Hospital, Avenida Montevideo, 18, 48013, Bilbao, Spain.
authors.forename: Izaskun
authors.initials: I
authors.lastname: Del Hoyo Aretxabala
authors.affiliation: Service of General and Digestive Surgery, Basurto University Hospital, Avenida Montevideo, 18, 48013, Bilbao, Spain.
authors.forename: Patricia
authors.initials: P
authors.lastname: Perez de Villarreal
authors.affiliation: Esophago-gastric Surgery and Robotic Unit, Service of General and Digestive Surgery, Basurto University Hospital, Avenida Montevideo, 18, 48013, Bilbao, Spain.
authors.forename: Jose Esteban
authors.initials: JE
authors.lastname: Bilbao Axpe
authors.affiliation: Service of General and Digestive Surgery, Basurto University Hospital, Avenida Montevideo, 18, 48013, Bilbao, Spain.
authors.forename: Jaime Jesus
authors.initials: JJ
authors.lastname: Mendez Martin
keywords: Achalasia; Bariatric surgery; Esophagectomy; Gastroesophageal reflux disease; Minimally invasive surgery; Robot-assisted surgery