Computer-assisted laparoscopic repair of „upside-down“ stomach with the Da Vinci system

Recently introduced telerobotic surgical systems attempt to elude the inherent limitations of traditional laparoscopic surgery. The first 15 cases were prospectively evaluated. Mixed hiatal and paraesophageal hernias with fixed intrathoracic partial or complete displacement of the stomach were treated using the Da Vinci^Ò robotic system. Tissue dissection, hiatoplasty and anterior hemifundoplication (Dor) were performed by the telerobotic system. There were no surgical complications. The system broke down in the fourth patient due to software defect. Advantages were seen in terms of the intrathoracic dissection of displaced stomach through a narrow hiatus, intracorporeal suturing due to six degrees of freedom plus grasping. Current lack of the appropriate robotic instruments for abdominal surgery as well as the enormous functional cost of the robotic system are considered to be its main disadvantage at the moment. The continuous evolution and upgrade of the system is quite promising so far. Telerobotic assisted hiatal hernia operation is feasible with many advantages compared to the traditional laparoscopic approach especially during the dissection in the mediastinum in patients with intrathoracic stomach. A prospective randomised trial is performed. Technological evolution will hopefully diminish the current problems and the costs associated with robotic surgery.

Keywords: Da Vinci, hiatal hernia, laparoscopy, stomach, upside-down