Dosch Michel, Chevallay Mickael, Jung Minoa K, Mönig Stefan
Surgery Department, The Division of Digestive Surgery, University Hospitals of Geneva, Geneva, Switzerland.
Innov Surg Sci. 2024 Jul 26;10(1):43-49. doi: 10.1515/iss-2023-0033. eCollection 2025 Mar.
Robotic surgery has become increasingly prevalent in UGI surgery over the last decade, particularly for treating hiatal hernias. Voluminous hiatal hernias, defined as the herniation of 30-50 % of the stomach into the thorax, often require surgical intervention due to associated dysphagia and potential severe complications. Given the challenges of repairing voluminous hiatal hernias, especially in elderly and fragile patients, the surgical technique should be optimal. Robotic surgery affords excellent visualization, allowing high mediastinal dissection and precise hiatus reconstruction. Despite the clear technical advantages, it remains to be demonstrated if the robotic approach matches the outcomes of conventional laparoscopic techniques. We review here the fundamentals of hiatal hernia surgery and describe our surgical technique using the da Vinci Xi robot to operate voluminous hiatal hernias. Additionally, we performed a systematic research analysis and selected recent publications focusing on robotic surgery for voluminous hiatal hernias. Recent studies report comparable complication rates, recurrence, and hospital stay lengths between robotic and laparoscopy surgery. Initial robotic procedures had longer operative times, which decreased with surgeon experience. Most of the studies were observational and retrospective, reporting the experience of a single center. Robotic surgery appears to be a viable option with similar complications rates to laparoscopic surgery under optimized conditions. Current literature supports the broader adoption of robotic surgery for voluminous hiatal hernias. However, prospective randomized studies are needed to further validate its use.
在过去十年中，机器人手术在胃肠外科手术中越来越普遍，尤其是在治疗食管裂孔疝方面。巨大食管裂孔疝被定义为30%-50%的胃疝入胸腔，由于相关的吞咽困难和潜在的严重并发症，通常需要手术干预。鉴于修复巨大食管裂孔疝的挑战，特别是在老年和体弱患者中，手术技术应达到最佳。机器人手术具有出色的可视化效果，能够进行高纵隔解剖和精确的裂孔重建。尽管有明显的技术优势，但机器人手术方法是否能与传统腹腔镜技术的效果相匹配仍有待证明。我们在此回顾食管裂孔疝手术的基本原理，并描述我们使用达芬奇Xi机器人治疗巨大食管裂孔疝的手术技术。此外，我们进行了一项系统的研究分析，并选择了最近关注机器人手术治疗巨大食管裂孔疝的出版物。最近的研究报告了机器人手术和腹腔镜手术在并发症发生率、复发率和住院时间方面具有可比性。最初的机器人手术操作时间较长，但随着外科医生经验的增加而减少。大多数研究是观察性和回顾性的，报告的是单一中心的经验。在优化条件下，机器人手术似乎是一种可行的选择，其并发症发生率与腹腔镜手术相似。目前的文献支持更广泛地采用机器人手术治疗巨大食管裂孔疝。然而，需要进行前瞻性随机研究以进一步验证其应用。
