Department of Thoracic Medicine and Surgery, Division of Thoracic Surgery, Temple University Hospital, Philadelphia, PA, USA.
Department of Surgical Oncology, Division of Thoracic Surgery, Fox Chase Cancer Center, Philadelphia, PA, USA.
Innovations (Phila). 2023 Jan-Feb;18(1):84-89. doi: 10.1177/15569845221150014. Epub 2023 Feb 6.
Surgical repair of paraesophageal hernias in patients with hostile abdomen is challenging. Despite its utility as an open procedure, the adoption of the minimally invasive Belsey Mark IV procedure has been limited because of the complexity of using traditional video-assisted thoracoscopic instrumentation. The robotic platform offers additional degrees of freedom, which enables minimally invasive transthoracic approach despite challenging anatomy. The purpose of this article is to describe a technique of robotic approach for the Belsey Mark IV operation.
We retrospectively reviewed 5 cases of the robotic Belsey Mark IV procedure completed at a single institution between June 2018 and November 2021. Data were collected from a review of the medical records, including operative reports, anesthesia records, imaging, and clinical notes. The operative technique is described in the present article. There were 4 men and 1 woman. The average age of the patients was 64.4 ± 13.6 years, with an average body mass index of 24.5 kg/m. Three patients had undergone previous transabdominal hiatal hernia repair, and 2 of them had 2 prior repairs. One patient underwent simultaneous pulmonary left lower lobectomy for cancer with the Belsey Mark IV procedure.
The average operative time was 209 ± 95 min (110 to 360 min). The average postoperative length of stay was 4.2 days, and 2 patients experienced complications including bleeding and persistent air leak (after lobectomy). The average blood loss was 67 ± 25 mL.
The robotic platform enables a transthoracic minimally invasive approach to the Belsey Mark IV operation.
对于合并敌对腹部的食管裂孔疝患者，外科修复具有挑战性。尽管作为一种开放性手术具有一定的作用，但微创的 Belsey Mark IV 手术的采用受到限制，因为使用传统的电视辅助胸腔镜器械比较复杂。机器人平台提供了更多的自由度，即使在具有挑战性的解剖结构下，也能实现微创经胸入路。本文的目的是描述一种用于 Belsey Mark IV 手术的机器人入路技术。
我们回顾性分析了 2018 年 6 月至 2021 年 11 月在一家机构完成的 5 例机器人 Belsey Mark IV 手术病例。数据来自病历回顾，包括手术报告、麻醉记录、影像学和临床记录。本文描述了手术技术。患者为 4 男 1 女，平均年龄为 64.4 ± 13.6 岁，平均体重指数为 24.5 kg/m。3 例患者曾行经腹食管裂孔疝修补术，其中 2 例有 2 次修补史。1 例患者同时行左侧下肺叶肺癌切除术和 Belsey Mark IV 手术。
平均手术时间为 209 ± 95 min（110 至 360 min）。平均术后住院时间为 4.2 天，2 例患者出现并发症，包括出血和持续的气胸（在肺叶切除术后）。平均出血量为 67 ± 25 mL。
机器人平台使 Belsey Mark IV 手术能够采用经胸微创入路。
