# 2425 Robotic-Assisted Laparoscopic Esophageal Surgery
Soji Ozawa, Toshiharu Furukawa, Go Wakabayashi, Nobutoshi Ando, Yuko Kitagawa, Masakai Kitajima, Tokyo, Japan
In 1997, the "master-slave" robot system was introduced in the clinical field for endoscopic surgery. Since March of 2000, we have used the da Vinci Surgical System (Intuitive Surgical, Inc., CA, USA), which consists of a surgeon's console, a patient-side cart, a high - performance vision system, and proprietary instruments. The purpose of this study was to clarify the usefulness of this system for endoscopic surgery, in particular esophageal surgery. We performed surgery using the da Vinci Surgical System in 22 cases with benign abdominal diseases; laparoscopic esophageal surgery in 12, laparoscopic cholecystectomy in 9, and inguinal hernia repair in 1 case. Among those cases who underwent esophageal surgery, we performed laparoscopic Nissen fundoplication in 8 cases, and laparoscopic Heller and Dor procedure in 4 cases, using the da Vinci system. The patient-side cart of the da Vinci system was placed on the left side of the patient, and a 3D camera and EndoWrists, which are proprietary instruments, were set up on it. We focused on the suturing steps using the da Vinci system. The entire suturing step (Nissen / Dor fundoplication) was successfully performed using the da Vinci system in all the patients. While the suturing time (178 +/- 15 seconds), including that required to insert the needle and tie the four knots for crural repair, using the da Vinci system was significantly shorter than that recorded during the surgery without using the da Vinci system (406 +/- 35 seconds, p = 0.0001), the suturing time (165 +/- 13 seconds) for wrapping was only slightly shorter (198 +/- 31 seconds, p = 0.3). The suturing time (185 +/- 11 seconds) for Dor suturing on the left side using the da Vinci system was significantly shorter than that recorded during the same surgery performed without using the da Vinci system (227 +/- 12 seconds, p = 0.0158). The suturing time (150 +/- 7 seconds) for Dor suturing on the right side using the da Vinci system was also significantly shorter than that recorded during the surgery performed without using the da Vinci system (210 +/- 10 seconds, p = 0.0001). It took about 15 minutes to set up the da Vinci Surgical System. There was no morbidity or mortality related to the use of this system for surgery. In conclusion, surgery using the da Vinci Surgical System is considered feasible, safe, and useful. The advantages of using the da Vinci system include its usefulness for suturing in narrow surgical fields, such as in the case of crural repair, and its usefulness for multiple suturings, such as in Dor fundoplication, and securing steady procedures through 3D view.
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