[Total endoscopic Nissen fundoplication with the robotic device "da Vinci" in children. Hemodynamics, gas exchange, and anesthetic management].

The robot device "da Vinci" represents the latest stage in laparoendoscopic surgery. We report the first two cases worldwide of endoscopic Nissen fundoplication with a telemanipulatory robot system in two children, aged 10 and 12 years. In addition to standard monitoring, we used invasive blood pressure monitoring during the 300 min periods of general anesthesia. Arterial blood gas samples were analyzed in short intervals. During surgery, which included 177 and 180 min periods of intraperitoneal insufflation of carbon dioxide, no significant changes of pH, PaO2, PaCO2, etCO2, heart rate, and mean arterial pressure were observed. Body temperature was maintained with an external warming blanket. Extubation was achieved immediately after the end of the operation, and both patients were discharged home on postoperative day 6. Robot-assisted techniques may possibly add significant progress and improvement to laparoendoscopic surgery. Nonetheless, we conclude that, despite our first encouraging results, potential risks of robot-assisted surgery have not yet been definitively defined. Therefore, patients are in need for intensive and even invasive monitoring, unless a larger number of patients has been studied.