title: Surgical treatment of hiatus hernia and gastroesophageal reflux disease in complex cases using robotic-assisted laparoscopic surgery: a prospective study/consistent experience in a single institution.
abstract: The aim of this study was to report our experience in robotic-assisted surgery of hiatus hernia and gastroesophageal reflux disease in a large series of complex cases. From March 2009 until July 2010, 21 patients were operated due to hiatus hernia or reflux disease using robotic-assisted surgery at Albert Einstein Hospital, São Paulo, Brazil. All patients were selected for the robotic approach because of the complexity of the cases (associated co-morbidity) such as: previous major upper abdominal surgery in 6 patients, hiatus hernia with paraesophageal involvement in 8 patients, obesity with a body mass index of over 29 kg/m(2) in 8 patients, and previous hiatus hernioplasty in 3 patients. Optimal trocar positioning, operating and setup times, conversion rate, intraoperative complications, and perioperative morbidity and mortality rate were analyzed. The mean operating time was reduced from 316 to 195 min after five procedures and the setup time from 20 to 10 min after five procedures. There were no conversions in this group of patients and also no complication or need of blood transfusion. Robotic-assisted fundoplication is feasible, safe and effective for treating hiatus hernias and gastroesophageal reflux disease, especially in complex cases because improved dissection in the esophageal hiatus region compensates for long operating times. Disadvantages are the high costs, the time to master the setup/system, and the necessity of exact trocar positioning.
authors.affiliation: Department of General, Gastric and Minimally Invasive Surgery, Albert Einstein Hospital, Rua Monte Aprazível, 149/61A, 04513-030, SP, São Paulo, Brazil. vschraibman@hotmail.com.|Department of Gastric Surgery, Federal University of São Paulo, São Paulo, Brazil. vschraibman@hotmail.com.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Schraibman
authors.affiliation: Department of General, Gastric and Minimally Invasive Surgery, Albert Einstein Hospital, Rua Monte Aprazível, 149/61A, 04513-030, SP, São Paulo, Brazil.
authors.forename: Antonio Luiz
authors.initials: AL
authors.lastname: de Vasconcellos Macedo
authors.affiliation: Department of General, Gastric and Minimally Invasive Surgery, Albert Einstein Hospital, Rua Monte Aprazível, 149/61A, 04513-030, SP, São Paulo, Brazil.|Department of Gastric Surgery, Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Samuel
authors.initials: S
authors.lastname: Okazaki
authors.affiliation: Department of General, Gastric and Minimally Invasive Surgery, Albert Einstein Hospital, Rua Monte Aprazível, 149/61A, 04513-030, SP, São Paulo, Brazil.|Department of Gastric Surgery, Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Fernando Concilio
authors.initials: FC
authors.lastname: Mauro
authors.affiliation: Department of General, Gastric and Minimally Invasive Surgery, Albert Einstein Hospital, Rua Monte Aprazível, 149/61A, 04513-030, SP, São Paulo, Brazil.
authors.forename: Marina Gabrielle
authors.initials: MG
authors.lastname: Epstein
authors.affiliation: Diagnosis Imaging Department, Federal University of Sao Paulo/Escola Paulista de Medicina, São Paulo, Brazil.
authors.forename: Suzan Menasce
authors.initials: SM
authors.lastname: Goldman
authors.affiliation: Department of General, Gastric and Minimally Invasive Surgery, Albert Einstein Hospital, Rua Monte Aprazível, 149/61A, 04513-030, SP, São Paulo, Brazil.|Department of Gastric Surgery, Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Suzana
authors.initials: S
authors.lastname: Lustosa
authors.affiliation: Department of General, Gastric and Minimally Invasive Surgery, Albert Einstein Hospital, Rua Monte Aprazível, 149/61A, 04513-030, SP, São Paulo, Brazil.|Department of Gastric Surgery, Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Delcio
authors.initials: D
authors.lastname: Matos
keywords: Hiatus hernia; Recurrence; Robotic surgery; Technique