Garsot Elisenda, Company-Se Georgina, Clavell Arantxa, Viciano Marta, Herrero Christian, Nescolarde Lexa
Department of Surgery, Faculty of Medicine, Universitat Autonoma de Barcelona, Campus UAB, Bellaterra, 08913, Barcelona, Spain.
Department of General and Digestive Surgery, Hospital Universitari Germans Trias I Pujol, Carretera del Canyet S/N, Badalona, 08916, Barcelona, Spain.
J Robot Surg. 2025 Jan 17;19(1):51. doi: 10.1007/s11701-024-02191-3.
New procedures like the robotic approach require proficiency to ensure patient safety and satisfactory functional results. Hiatal hernia surgery serves as a suitable training procedure for upper gastrointestinal tract surgeons transitioning to the robotic approach. This study aims to evaluate the outcomes of implementing the robotic approach in hiatal hernia surgery at a tertiary hospital and to assess the associated learning curve. A retrospective review was conducted on 54 patients (58 surgeries) between June 2019 and March 2024, including both primary and revision robotic antireflux surgeries. The study focused on perioperative outcomes, symptom resolution, and the surgical learning curve, assessed using Cumulative Sum analysis. The results showed that global surgical time averaged 124 ± 57 (54-350) min, 127 ± 38 (116-139) for Primary Surgery and 164 ± 84 (115-212) min for Revisional Surgery. There were no conversions to laparoscopic or open approach. The global median of hospital stay was 2 days (2 for Primary Surgery and 3 for Revisional Surgery) and three patients required readmission (2 for Primary Surgery and 1 for Revisional Surgery). Postoperative complications occurred in 3 patients. Symptom resolution was achieved in 90% of Primary Surgery group and 85.7% of Revisional Surgery group. Learning curve described three phases: 1-training (case 1 to 14), 2-plateau (15 to 25) and 3-expertise phase (25 onwards). The robotic approach in hiatal hernia surgery is feasible with minimal morbidity, short hospital stays, and excellent functional results. With previous experience in laparoscopic approach and esophagogastric surgery the learning curve can be reduced to 14 procedures.
像机器人手术方法这样的新手术需要熟练掌握以确保患者安全和获得满意的功能结果。食管裂孔疝手术是上消化道外科医生向机器人手术方法过渡的合适训练手术。本研究旨在评估在一家三级医院实施机器人手术方法进行食管裂孔疝手术的结果，并评估相关的学习曲线。对2019年6月至2024年3月期间的54例患者（58例手术）进行了回顾性研究，包括初次和翻修机器人抗反流手术。该研究重点关注围手术期结果、症状缓解情况以及手术学习曲线，采用累积和分析进行评估。结果显示，总体手术时间平均为124±57（54 - 350）分钟，初次手术为127±38（116 - 139）分钟，翻修手术为164±84（115 - 212）分钟。没有转为腹腔镜或开放手术的情况。住院时间的总体中位数为2天（初次手术为2天，翻修手术为3天），3例患者需要再次入院（初次手术2例，翻修手术1例）。3例患者发生术后并发症。初次手术组90%的患者和翻修手术组85.7%的患者症状得到缓解。学习曲线分为三个阶段：1. 训练阶段（第1例至第14例），2. 平稳阶段（第15例至第25例），3. 精通阶段（第25例及以后）。机器人手术方法用于食管裂孔疝手术是可行的，发病率低，住院时间短，功能结果良好。有腹腔镜手术和食管胃手术经验的话，学习曲线可缩短至14例手术。
