Robotic Nissen Fundoplication for gastro-oesophageal reflux disease
January 19, 2014
A. Parisi
Gastroesophageal reflux disease is a significant public health concern. Robotic fundoplication has recently been introduced into clinical practice with the aim of improving surgical dexterity. We report a video of a case of Nissen fundoplication performed with the ausilium of the Da Vinci Surgical System. A 45-year-old man was admitted to the Department of Digestive Surgery and Liver Unit of St. Maria Hospital, Terni, Italy. During case history, the patient reported a ten years of heartburn, regurgitation and trouble swallowing. The medical management failed with inadequate symptoms control. So considering the quality of life of the patient we decided for surgery. Estimated intraoperative bleeding was 50ml and no blood transfusions were necessary in the perioperative period. Operative time was 190 minutes. Hospital stay (2 days) was particularly short and regular: in first postoperative day the patient started oral liquid intake and referred Visual Analogue Scale (VAS) score for pain was 3. Physical examination at discharge showed not painful, palpable abdomen, normal bowel functioning and hematological laboratory values. No complications were reported peri-operatively and at follow-up, a quick return to daily activities was demonstrated by the Short Form-12 (SF-12) assessment scale. In particular the patient answers no limitations in moderate activities or problems with work and other regular daily activities as a result of their phisical health. During a 24 months follow-up the patient was completely free of reflux symptoms with no dysphagia or recurrent hiatal hernia. Advantages of Da Vinci Surgical system seems to be the dexterity of the Endowrist, that could extend the feasibility of a minimally invasive approach to patients requiring advanced suturing, precise tissue dissection and tridimensional visualization of the operative field. Our experience demonstrates the feasibility of the robotic surgical approach but new evidences are needed to clarify its effective role.
