Department of General Surgery, Hadassah Hebrew- University Medical Center, Jerusalem, Israel.
Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
Surg Endosc. 2024 Mar;38(3):1180-1190. doi: 10.1007/s00464-023-10618-5. Epub 2023 Dec 11.
Achalasia is a rare disorder of the esophagus characterized by motor dysfunction in the esophagus and relaxation failure of the lower esophageal sphincter (LES). Currently, surgical myotomy procedures are considered the standard of care. Robotic Heller's myotomy (RHM) with fundoplication has been gaining popularity due to documented advantages in the precision of myotomy as well as avoiding the potential reflux following per-oral endoscopic myotomy (POEM). To the best of our knowledge, RHM has thus far has been performed exclusively by the da Vinci surgical system. The new Hugo RAS™ system offers a unique modular design and an open console which offers better maneuverability and docking options. In this study, we present the first worldwide series of patients undergoing RHM using the new Hugo RAS™ platform. Our objective is to propose optimal operating configuration and setup to fully harness the advantages of the unique modular design of this system.
Ten consecutive achalasia patients underwent Robotic Heller's myotomy (RHM) with the Hugo RAS™ system. We prospectively collected patient data, including demographics, comorbidities, ASA class, Eckardt scores, pre-operative manometric data, and EndoFlip parameters. Additionally, we recorded the docking and total operative times.
Between December 2022 and August 2023, 10 patients underwent RHM with the Hugo™ RAS system. Patients had a median age of 42.5 years, 60% were female, and mean BMI was 23.2. Fifty percent had achalasia type 2 and 50% type 1. The median pre-operative integrated relaxation pressure (IRP) was 24.9. Median docking time was 10 min and overall operative time was 129.5 min. All patients, except one with acute coronary syndrome, had an uneventful peri-operative course and were discharged on post-operative day 2.
The Hugo™ RAS system is well designed for robotic Heller myotomy. The operative and clinical results are similar to the currently used robotic system; however, the modular design of the system has some differences. These translate to better docking angles and maneuverability as well as console surgeon's ergonomics. Further experience is needed to explore the advantages of the system's modular design and function.
贲门失弛缓症是一种罕见的食管运动障碍性疾病，其特征为食管动力障碍和食管下括约肌（LES）松弛失败。目前，手术肌切开术被认为是标准的治疗方法。由于记录到肌切开术的精确性以及避免经口内镜肌切开术（POEM）后的潜在反流，机器人 Heller 肌切开术（RHM）联合胃底折叠术越来越受欢迎。据我们所知，到目前为止，RHM 仅由达芬奇手术系统完成。新型 Hugo RAS™系统提供独特的模块化设计和开放式控制台，具有更好的操作性和对接选项。在这项研究中，我们展示了全球首例使用新型 Hugo RAS™平台进行 RHM 的患者系列。我们的目标是提出最佳的操作配置和设置，以充分利用该系统独特的模块化设计的优势。
10 例连续贲门失弛缓症患者接受了使用 Hugo RAS™系统的机器人 Heller 肌切开术（RHM）。我们前瞻性收集了患者数据，包括人口统计学、合并症、ASA 分级、Eckardt 评分、术前测压数据和 EndoFlip 参数。此外，我们还记录了对接和总手术时间。
2022 年 12 月至 2023 年 8 月期间，10 例患者接受了 Hugo™ RAS 系统的 RHM。患者的中位年龄为 42.5 岁，60%为女性，平均 BMI 为 23.2。50%为贲门失弛缓症 2 型，50%为 1 型。中位术前综合松弛压力（IRP）为 24.9。中位对接时间为 10 分钟，总手术时间为 129.5 分钟。除 1 例患有急性冠状动脉综合征的患者外，所有患者均顺利度过围手术期，术后第 2 天出院。
Hugo™ RAS 系统非常适合机器人 Heller 肌切开术。手术和临床结果与目前使用的机器人系统相似；然而，系统的模块化设计存在一些差异。这些转化为更好的对接角度和操作性以及控制台外科医生的人体工程学。需要进一步的经验来探索系统模块化设计和功能的优势。
