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The first year is the hardest: a comparison of early versus late experience after the introduction of robotic hiatal hernia repair

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Abstract

While the majority of the literature written concerning minimally invasive hiatal hernia repair involves laparoscopy, little has been written concerning the transition to a robotic technique. We present our experience, with a transparent analysis of data, with regard to the introduction of robotic paraesophageal hernia (PEH) repair by an experienced laparoscopic surgeon. We reviewed our first 30 consecutive patients who underwent robotic PEH over a 2-year period after the introduction of robotic surgery at our institution. Patients were divided into two groups: the early experience group (procedures performed within the first year of introduction of robotic technique, n = 13) and a late experience group (procedures performed in the second year, n = 17). All procedures were performed by a single experienced foregut surgeon. The mean operative time for the early group was significantly greater than for the late group, 184 min versus 142 min, respectively (p < 0.01). Four patients in the early group required conversion to open, while zero patients in the late group required conversion (p = 0.03). Patient demographics and complications did not differ significantly between the two patient populations. The early robotic hiatal hernia repair experience can be more difficult than expected, even in the hands of an experienced laparoscopic team. We identify several areas of improvement including patient positioning, operating room team training, and technical experience. This data can help other surgeons prepare for the transition to robotic foregut surgery.

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Authors and Affiliations

  1. Highlander Surgical Associates, 301 Highlander Blvd, Ste 101, Arlington, TX, 76018, USA

    Kimberly Washington

  2. Northwest Minimally Invasive Surgery, 2222 NW Lovejoy St. Ste 232, Portland, OR, 97210, USA

    Jeffrey R. Watkins

  3. Department of Surgery, Methodist Richardson Medical Center, Richardson, TX, USA

    D. Rohan Jeyarajah

Authors
  1. Kimberly Washington
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  2. Jeffrey R. Watkins
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  3. D. Rohan Jeyarajah
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Corresponding author

Correspondence to D. Rohan Jeyarajah.

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Drs. Washington, Watkins, and Jeyarajah declare they have no conflict of interest or funding sources to disclose.

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There were no animals involved in this study.

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As this study was retrospective in nature, information was obtained from review of patient chart details; therefore, informed consent was not necessary.

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Washington, K., Watkins, J.R. & Jeyarajah, D.R. The first year is the hardest: a comparison of early versus late experience after the introduction of robotic hiatal hernia repair. J Robotic Surg 14, 205–210 (2020). https://doi.org/10.1007/s11701-019-00967-6

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  • DOI: https://doi.org/10.1007/s11701-019-00967-6

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