Description
The webinar on “Technical Tips for Safer Robotic Large Paraesophageal Hernia Repairs” will focus on advanced surgical strategies to enhance precision, safety, and outcomes in complex hernia repairs. Experts will discuss key technical considerations, including patient selection, port placement, dissection techniques, and strategies to prevent intraoperative complications. The session will also highlight the advantages of robotic platforms in improving visualization, ergonomics, and suturing in large paraesophageal hernias. Participants will gain valuable insights into refining their operative skills and adopting evidence-based practices for safer and more effective robotic hernia repair procedures.
Summary Listen
- The speaker, a surgeon specializing in upper GI surgery with extensive robotic experience, emphasizes the importance of expertise in assessing and approaching the gastroesophageal junction (GEJ). General surgery training is often insufficient, and robotic surgery, while enabling more surgeons to access the area, should not be considered an easy solution. Hiatal hernia repair presents various challenges that can lead to complications and recurrence.
- Paraesophageal hernias, an uncommon form of hiatal hernia predominantly affecting older adults, require careful management. These hernias are classified into four types, with mixed hernias being the most prevalent. Symptoms can range from respiratory issues and dysphagia to anemia and acute complications like torsion and ischemia. Repair is generally recommended for all symptomatic hernias, with thorough preoperative workup being crucial.
- Robotic repair is preferred for complicated hiatal and paraesophageal hernias due to its efficiency, ergonomics, precision, and enhanced visualization. The speaker's team utilizes intraoperative navigation with ICG (Indocyanine Green) to identify the esophagus during reoperations. The stable 3D stereoscopic view and instruments with 7 degrees of freedom provided by the robot facilitate complex maneuvers.
- The speaker details their personal experience with robotic GI procedures, including hiatal hernia repairs and redo cases. A combination of robotic techniques, adhesiolysis, and thoracotomy with Belsey Mark IV fundoplication is used for redo cases. Results are generally in line with international standards, with complications recognized and addressed intraoperatively.
- Key aspects of the procedure include protecting vagal nerves, managing critical vessels, and considering mesh placement. Splenic attachments are handled more safely with robotic assistance. The speaker demonstrates specific surgical steps through videos, emphasizing the importance of fundus mobilization, hiatus suturing, and wrap fixation.
- The speaker shares a detailed example of a redo case involving a large mesh, highlighting the difficulties and potential complications associated with mesh use. An ICG mapping procedure is employed to recognize the GEJ during the reoperation. A thoracic approach with Belsey Mark IV fundoplication is utilized for reconstruction in challenging cases.
- Outcomes include a low vagal injury rate, occasional pneumothorax, and rare recurrences. A detailed discussion and video demonstrate the benefits and technical applications of ICG mapping.
- Research on robotic surgery shows mixed results, with some studies indicating equivalent outcomes to laparoscopy in simple cases. Other studies suggest advantages such as shorter hospital stays and lower conversion rates with robotic approaches, particularly in paraesophageal hernias. The potential for economic benefits due to reduced complications and shorter recovery times is also noted. Augmented reality integration will revolutionize the precision of Hiatal Hernia and AI for Autonomous assistance, which is expected in the near future.
Sample Certificate
About the Speakers
Dr. Savvas Hirides
Clinical Assistant Professor, University of Nicosia, Cyprus
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