Basem G Soliman1, Duc T Nguyen2, Edward Y Chan1,3, Ray K Chihara1, Leonora M Meisenbach1, Edward A Graviss2, Min P Kim4,5. 1. Division of Thoracic Surgery, Department of Surgery, Houston Methodist Hospital, 6550 Fannin Street, SM1661, Houston, TX, 77030, USA. 2. Department of Pathology & Genomic Medicine, Houston Methodist Hospital, Houston, TX, USA. 3. Department of Surgery, Weill Cornell Medical College, Houston Methodist Hospital, Houston, TX, USA. 4. Division of Thoracic Surgery, Department of Surgery, Houston Methodist Hospital, 6550 Fannin Street, SM1661, Houston, TX, 77030, USA. mpkim@houstonmethodist.org. 5. Department of Surgery, Weill Cornell Medical College, Houston Methodist Hospital, Houston, TX, USA. mpkim@houstonmethodist.org.
Abstract
BACKGROUND: We postulated that the use of robotics may improve outcomes in hiatal hernia repair. METHODS: We performed a retrospective analysis of a prospectively collected Society of Thoracic Surgery database at a single institution of patients who underwent elective hiatal hernia repair from 2012 to 2017 using either laparoscopy or the da Vinci Xi robot. We compared patient characteristics and outcomes and then performed univariate and multivariate logistic regression modeling to determine the factors associated with postoperative morbidity. RESULTS: There were 293 consecutive patients who underwent elective hiatal hernia repair using either a laparoscopic (n = 151) or a robotic (n = 142) technique. There were no significant differences in age, gender, BMI, smoking history, presence of comorbidity, or hiatal hernia type. Seventy percent of the cases were a repair of either type III or type IV hiatal hernia. There were significantly higher ASA III and IV (7.9% vs. 4.2%, P = 0.03), higher Toupet fundoplication (83.4% vs. 44.4%, P < 0.001), and lower redo-repair (7.3% vs. 20.4%, P = 0.001) in the laparoscopic group compared to the robotic group. The hospital length of stay was significantly shorter (1.3 ± 1.8 vs. 1.8 ± 1.5 days, P = 0.003) and there were significantly lower rates of complications (6.3 vs. 19.2%, P = 0.001) after robotic compared to laparoscopic hiatal hernia repair. There was no difference in readmission rate and mortality. Multiple logistic regression analysis showed that older age and laparoscopic technique were associated with higher complications after surgery. CONCLUSION: The use of the Da Vinci Xi robot in our institution was associated with improved outcomes compared to laparoscopic hiatal hernia repair despite a higher incidence of re-operative cases in the robotic group. Thus, short-term outcomes of Da Vinci Xi robot-assisted hiatal hernia repair are not inferior to laparoscopic hiatal hernia repair. Further studies are needed to determine if Da Vinci Xi robot provides superior short-term and long-term outcome in treatment of symptomatic hiatal hernia.
BACKGROUND: We postulated that the use of robotics may improve outcomes in hiatal hernia repair. METHODS: We performed a retrospective analysis of a prospectively collected Society of Thoracic Surgery database at a single institution of patients who underwent elective hiatal hernia repair from 2012 to 2017 using either laparoscopy or the da Vinci Xi robot. We compared patient characteristics and outcomes and then performed univariate and multivariate logistic regression modeling to determine the factors associated with postoperative morbidity. RESULTS: There were 293 consecutive patients who underwent elective hiatal hernia repair using either a laparoscopic (n = 151) or a robotic (n = 142) technique. There were no significant differences in age, gender, BMI, smoking history, presence of comorbidity, or hiatal hernia type. Seventy percent of the cases were a repair of either type III or type IV hiatal hernia. There were significantly higher ASA III and IV (7.9% vs. 4.2%, P = 0.03), higher Toupet fundoplication (83.4% vs. 44.4%, P < 0.001), and lower redo-repair (7.3% vs. 20.4%, P = 0.001) in the laparoscopic group compared to the robotic group. The hospital length of stay was significantly shorter (1.3 ± 1.8 vs. 1.8 ± 1.5 days, P = 0.003) and there were significantly lower rates of complications (6.3 vs. 19.2%, P = 0.001) after robotic compared to laparoscopic hiatal hernia repair. There was no difference in readmission rate and mortality. Multiple logistic regression analysis showed that older age and laparoscopic technique were associated with higher complications after surgery. CONCLUSION: The use of the Da Vinci Xi robot in our institution was associated with improved outcomes compared to laparoscopic hiatal hernia repair despite a higher incidence of re-operative cases in the robotic group. Thus, short-term outcomes of Da Vinci Xi robot-assisted hiatal hernia repair are not inferior to laparoscopic hiatal hernia repair. Further studies are needed to determine if Da Vinci Xi robot provides superior short-term and long-term outcome in treatment of symptomatic hiatal hernia.
Authors: James G Bittner; Sameer Alrefai; Michelle Vy; Micah Mabe; Paul A R Del Prado; Natasha L Clingempeel Journal: Surg Endosc Date: 2017-07-20 Impact factor: 4.584
Authors: Maria S Altieri; Jie Yang; Dana A Telem; Jiawen Zhu; Caitlin Halbert; Mark Talamini; Aurora D Pryor Journal: Surg Endosc Date: 2015-07-03 Impact factor: 4.584
Authors: Alexander C Mertens; Rob C Tolboom; Hana Zavrtanik; Werner A Draaisma; Ivo A M J Broeders Journal: Surg Endosc Date: 2018-10-22 Impact factor: 4.584
Authors: Raul Sebastian; Omar M Ghanem; Jorge Cornejo; Thomas Ruttger; Matthew Mayuiers; Gina Adrales; Christina Li Journal: Surg Endosc Date: 2022-01-12 Impact factor: 3.453
Authors: Alexander Wilhelm; Fabio Nocera; Fiorenzo V Angehrn; Martin Bolli; Romano Schneider; Luca Koechlin; Diana L Daume; Lana Fourie; Daniel Steinemann; Markus von Flüe; Ralph Peterli Journal: Surg Endosc Date: 2021-02-01 Impact factor: 4.584
Authors: Sujay Kulshrestha; Haroon M Janjua; Corinne Bunn; Michael Rogers; Christopher DuCoin; Zaid M Abdelsattar; Fred A Luchette; Paul C Kuo; Marshall S Baker Journal: J Am Coll Surg Date: 2021-05-17 Impact factor: 6.532
Authors: Yalini Vigneswaran; Ava F Bryan; Brian Ruhle; Lawrence J Gottlieb; John Alverdy Journal: J Gastrointest Surg Date: 2021-09-10 Impact factor: 3.452