Recent Approval by the FDA has opened the field of robotically assisted GI surgery. One system, in which the surggeon works at a console, provides steroscopic detailed visualization, 6 degrees of freedom plus grasp in two robotic wrists, tremor elimination and motion scaling.
Aim: To report our initial experience with robotically assisted GI tract surgery.
Methods: Data were collected prospectively and analyzed.
Results:Thirty patients from August to December 2000 underwent attempted Nissen Fundoplication(15), cholecystectomy (6),laparoscopically assisted bowel resection (3),Heller myotomy and Toupet fundoplication (3), exploratory laparoscopy (1), pyloroplasty (1) and splenectomy (1). In most cases, one or two additional 5mm non-robotic ports were used to facilitate the procedure. Two patients (7%), were converted to open (splenectomy due to bleeding, cholecystectomy due to inflammation). Eight patients (27%) had undergone previous abdominal surgery.Average age at operation was 50 years (±17,21-77),weight was 51 kg (18±,51-130) and height was 164 cms(±20, 102-201).Average time to engage the robotic system to the patient was 4.0 minutes (±3.5, 0.83-15), time of system use was 113 (±53,17-195), and total operative time was 167 minutes (±57, 65-260). In the authors judgement , 3 procedures could not have been accomplished with standard laproscopy (extensive adhesiolysis necessary for bowel mobilization, difficult crural closure during laparoscopic Nissen fundoplication, and inability to exhaustively examine the small bowel during exploratory laparoscopy). There were no intra-operative complications. Two patients required re-operation (open), one from gastric leak from the non-robotic portion of a Nissen fundoplication and one who required modification of their Nissen wrap.
Conclusions:Successful robotic assisted GI surgery requires skill in established laparoscopic techniques, familiarity and training with technical aspects of the system, strategic port placement, an anesthesia team willing to accomodate the system, and team communication/coordinatioin during procedures. Robotic systems allow more difficult operations to be performed via a minimally invasive approach, and will offer the future promise of at -distance surgical intervention
