- Email: [email protected]
Robotic Nissen fundoplication for gastro-oesophageal reflux disease with hiatal hernia (with video)
Journal of Visceral Surgery (2016) 153, 145—146
Available online at
ScienceDirect www.sciencedirect.com
VISCERAL SURGERY VIDEOS
Robotic Nissen fundoplication for gastro-oesophageal reflux disease with hiatal hernia (with video) J. Desiderio a,∗, S. Trastulli a, F. Ricci a, R. Cirocchi a, E. Pressi a, C. Boselli c, G. Noya c, D. Pironi b, V. D’Andrea b, A. Santoro b, A. Parisi a a
Department of Digestive Surgery, St. Mary’s Hospital, University of Perugia, Terni, Italy Department of surgical sciences, Sapienza university of Rome, Rome, Italy c Department of general and oncologic surgery, university of Perugia, Perugia, Italy b
Available online 22 January 2016
KEYWORDS Robotic surgery; Nissen fundoplication; Hiatal hernia; Gastro-oesophageal reflux disease
∗
Gastroesophageal reflux disease is a significant public health concern. Antireflux surgery has become an accepted solution for many patients especially since the introduction of minimally invasive procedures [1]. Robotic surgery provides a three-dimensional vision with articulated instruments resulting in greater dexterity for surgeons [2,3]. This video shows different steps necessary to perform a posterior fundoplication using Nissen-Rossetti technique. The patient is placed in a supine reversed Trendelenburg position. A 12-mm trocar, for the robotic camera, is positioned in the left paraumbilical region. Two 8-mm robotic ports are inserted into the right hypochondrium and the left subcostal region. A 12-mm extra-port for accessory instruments controlled by the assistant is placed at the supraumbilical region. Mobilisation of the esophagus requires the opening of the upper part of the small omentum (pars condensa). The phrenoesophageal membrane is incised, using the cautery hook. The diaphragm pillars are then visualized. A ribbon is passed around the esophagus, allowing the enlargement of the dissection and lowering the esophagus by 4—5 cm. The left pillar is sutured to the right one avoiding oesophageal stenosis. The dissection of the esophagus must be sufficient to allow the large gastric tuberosity to pass freely at the posterior part of the esophagus. A Nissen fundoplication with the Rossetti modification is carried out, paying attention to the preservation of the vagus nerves. The large tuberosity is sutured onto itself using simple stitches, wrapping the abdominal esophagus with a 360◦ angle. The height of the fundoplication is expected to be about 2—3 cm. This video is useful for all surgeons having to perform a laparoscopic or robotic Nissen-Rossetti fundoplication.
Corresponding author. E-mail address: [email protected] (J. Desiderio).
http://dx.doi.org/10.1016/j.jviscsurg.2015.11.005 1878-7886/© 2015 Elsevier Masson SAS. All rights reserved.
146
J. Desiderio et al.
Appendix A. Supplementary data
References
Supplementary data associated with this article can be found, in the online version, at http://dx.doi.org/10.1016/ j.jviscsurg.2015.11.005.
[1] Fuchs KH, Feussner H, Bonavina L, Collard JM, Coosemans W, The European Study Group for Antireflux Surgery (ESGARS). Current status and trends in laparoscopic antireflux surgery: results of a consensus meeting. Endoscopy 1997;29(4):298—308. [2] Parisi A, Nguyen NT, Reim D, et al. Current status of minimally invasive surgery for gastric cancer: a literature review to highlight studies limits. Int J Surg 2015;17:34—40. [3] Broeders JA, Broeders EA, Watson DI, Devitt PG, Holloway RH, Jamieson GG. Objective outcomes 14 years after laparoscopic anterior 180-degree partial versus nissen fundocplication: results from a randomized trial. Ann Surg 2013;258:233—9.
Disclosure of interest The authors declare that they have no competing interest.
Available online at
ScienceDirect www.sciencedirect.com
VISCERAL SURGERY VIDEOS
Robotic Nissen fundoplication for gastro-oesophageal reflux disease with hiatal hernia (with video) J. Desiderio a,∗, S. Trastulli a, F. Ricci a, R. Cirocchi a, E. Pressi a, C. Boselli c, G. Noya c, D. Pironi b, V. D’Andrea b, A. Santoro b, A. Parisi a a
Department of Digestive Surgery, St. Mary’s Hospital, University of Perugia, Terni, Italy Department of surgical sciences, Sapienza university of Rome, Rome, Italy c Department of general and oncologic surgery, university of Perugia, Perugia, Italy b
Available online 22 January 2016
KEYWORDS Robotic surgery; Nissen fundoplication; Hiatal hernia; Gastro-oesophageal reflux disease
∗
Gastroesophageal reflux disease is a significant public health concern. Antireflux surgery has become an accepted solution for many patients especially since the introduction of minimally invasive procedures [1]. Robotic surgery provides a three-dimensional vision with articulated instruments resulting in greater dexterity for surgeons [2,3]. This video shows different steps necessary to perform a posterior fundoplication using Nissen-Rossetti technique. The patient is placed in a supine reversed Trendelenburg position. A 12-mm trocar, for the robotic camera, is positioned in the left paraumbilical region. Two 8-mm robotic ports are inserted into the right hypochondrium and the left subcostal region. A 12-mm extra-port for accessory instruments controlled by the assistant is placed at the supraumbilical region. Mobilisation of the esophagus requires the opening of the upper part of the small omentum (pars condensa). The phrenoesophageal membrane is incised, using the cautery hook. The diaphragm pillars are then visualized. A ribbon is passed around the esophagus, allowing the enlargement of the dissection and lowering the esophagus by 4—5 cm. The left pillar is sutured to the right one avoiding oesophageal stenosis. The dissection of the esophagus must be sufficient to allow the large gastric tuberosity to pass freely at the posterior part of the esophagus. A Nissen fundoplication with the Rossetti modification is carried out, paying attention to the preservation of the vagus nerves. The large tuberosity is sutured onto itself using simple stitches, wrapping the abdominal esophagus with a 360◦ angle. The height of the fundoplication is expected to be about 2—3 cm. This video is useful for all surgeons having to perform a laparoscopic or robotic Nissen-Rossetti fundoplication.
Corresponding author. E-mail address: [email protected] (J. Desiderio).
http://dx.doi.org/10.1016/j.jviscsurg.2015.11.005 1878-7886/© 2015 Elsevier Masson SAS. All rights reserved.
146
J. Desiderio et al.
Appendix A. Supplementary data
References
Supplementary data associated with this article can be found, in the online version, at http://dx.doi.org/10.1016/ j.jviscsurg.2015.11.005.
[1] Fuchs KH, Feussner H, Bonavina L, Collard JM, Coosemans W, The European Study Group for Antireflux Surgery (ESGARS). Current status and trends in laparoscopic antireflux surgery: results of a consensus meeting. Endoscopy 1997;29(4):298—308. [2] Parisi A, Nguyen NT, Reim D, et al. Current status of minimally invasive surgery for gastric cancer: a literature review to highlight studies limits. Int J Surg 2015;17:34—40. [3] Broeders JA, Broeders EA, Watson DI, Devitt PG, Holloway RH, Jamieson GG. Objective outcomes 14 years after laparoscopic anterior 180-degree partial versus nissen fundocplication: results from a randomized trial. Ann Surg 2013;258:233—9.
Disclosure of interest The authors declare that they have no competing interest.