title: Two years of experience with robot-assisted anti-reflux surgery: A retrospective cohort study.
abstract: OBJECTIVE
  Robot-assisted anti-reflux surgery (RAAS) is an alternative to conventional laparoscopic anti-reflux surgery (CLAS). The purpose of this study was to evaluate initial Danish experiences with robot-assisted anti-reflux surgery compared to conventional laparoscopic anti-reflux surgery incorporating follow-up and evaluation of possible learning curve.
  
  
  METHODS
  Patients undergoing primary RAAS or CLAS at The Department of Surgery A, Odense University Hospital and The Department of General Surgery, Kolding Hospital from April 2013 to April 2015 was included. Demographic data, comorbidity, docking time, length of procedure, type of fundic wrap as well as perioperative complications and postoperative complications, need for reoperation or any upper gastrointestinal endoscopy from surgery to final follow-up was retrospectively extracted from patient records.
  
  
  RESULTS
  103 patients were included in this study. 39 patients underwent RAAS and 64 patients underwent CLAS. There were no statistically significant differences in demographic data or comorbidities except distribution of heart disease (RAAS: 5.1% vs. CLAS: 18.8%, p = 0.05) and previous abdominal surgery (RAAS: 28.2% vs. CLAS: 48.4%, p = 0.04). Duration of surgery was significantly increased in patients undergoing RAAS (RAAS: 135 ± 27 min vs. CLAS: 86 ± 19 min, p < 0.01). There was no statistical significant difference in intraoperative complications (p = 0.20), 30-day postoperative complication rate (p = 0.20) or mortality (p = 1.00). At follow-up in April 2016, there were no statistically significant differences in patients having undergone upper endoscopy postoperatively (p = 0.92), the use of anti-secretory drugs (p = 0.46) or patients having undergone reoperation (p = 0.60). Reasons for reoperation were significantly dependent on type of fundic wrap with reoperation of Nissen fundoplication being dysphagia and reoperation of Toupet being recurrent reflux (p = 0.008). There was no clearly determined learning curve.
  
  
  CONCLUSIONS
  RAAS was safe, feasible and with equal efficacy to CLAS. There were however no particular advantages to performing antireflux surgery as robot-assisted procedures neither intra-operatively nor at follow-up.
authors.affiliation: Department of General Surgery, Kolding Hospital, Skovvangen 2-8, DK-6000 Kolding, Denmark. Electronic address: jsanberg@dadlnet.dk.
authors.forename: Jonas Sanberg
authors.initials: JS
authors.lastname: Jensen
authors.affiliation: Department of General Surgery, Kolding Hospital, Skovvangen 2-8, DK-6000 Kolding, Denmark.
authors.forename: Henning Kold
authors.initials: HK
authors.lastname: Antonsen
authors.affiliation: Department of Surgery A, Odense University Hospital, Sdr Boulevard 29, DK-5000 Odense C, Denmark.
authors.forename: Jesper
authors.initials: J
authors.lastname: Durup
mesh_terms: D000328:Adult; D000368:Aged; D003680:Deglutition Disorders / Q000209:etiology / Q000601:surgery; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication / Q000009:adverse effects / Q000379:methods; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006785:Hospitals, University; D006801:Humans; D007431:Intraoperative Complications; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011184:Postoperative Period; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome
keywords: Follow-up studies; Fundoplication; Gastroesophageal reflux; Laparoscopy; Robotic surgical procedures; Treatment outcome