Abstract:
BACKGROUND:Recurrent gastroesophageal reflux symptoms in adolescents and young adults who underwent fundoplication in childhood present a technical challenge for the surgeon. The distal oesophagus and hiatus are difficult to access by laparotomy, the anatomy is modified by the primary procedure, and there are often dense adhesions between important structures. Robot-assisted surgery may be advantageous, because of the three dimensional (3D) view and the multiaxial freedom of movement afforded by the system. PURPOSE:To describe our experience with robot-assisted Nissen re-fundoplication in adolescents who underwent primary fundoplication in childhood. METHODS:The video shows the individual steps in robotic repeated fundoplication using the robotic system (Intuitive Surgical Inc., Sunnyvale, CA, USA). Three patients were operated with fundoplication at the age of 15 ± 2 years due to gastroesophageal reflux disease. After an average of 11,8 years after the primary procedure, they showed pathological reflux symptoms, which indicated repeated Nissen fundoplication. RESULTS AND DISCUSSION:The 3D vision of the robotic system provided the surgeon with a good overview of the operative field. In addition, it allowed accurate dissection of the predictable adhesions around the hiatus. Mean operating time from incision to closure in the robot-assisted re-fundoplication was 174 min. Neither intra- nor postoperative complications occurred. As in conventional laparoscopic technique, there is a learning curve for the robotic surgery that can be appreciated from our data. Shorter dissection times and simplified dissection are potential benefits that need to be balanced with the higher cost of the robotic technique. CONCLUSION:Robot-assisted re-fundoplication is an excellent alternative to the conventional laparoscopic procedure in young adults with recurrent gastroesophageal symptoms, who had a fundoplication in early childhood. The 3D-vision and the multi-axial free mobility of the instruments facilitate precise dissection that consider anatomic structures and adhesions. ZIELSETZUNG:Der vorliegende Beitrag zeigt Schritt für Schritt die roboterassistierte Refundoplicatio bei jugendlichen Patienten, die in ihrer Kindheit eine Fundoplicatio erhalten hatten. EINLEITUNG:Das Wiederauftreten von gastroösophagealem Reflux bei Jugendlichen und jungen Erwachsenen, die eine Fundoplicatio im Kindes- oder Kleinkindalter hatten, stellt eine große chirurgische und technische Herausforderung für den Chirurgen dar. Zum einen ist der distale Ösophagus und Hiatus oesophageus bei einer Laparotomie nur schwer zugänglich, zum anderen handelt es sich um eine durch die Voroperation veränderte Anatomie. Außerdem sind wichtige Strukturen in diesem Bereich meist dicht verwachsen. Der Einsatz der roboterassistierten Chirurgie kann hier evtl. durch die 3-dimensionale (3-D) Sicht und die multiaxiale Bewegungsfreiheit der Instrumente intraoperative Vorteile bieten. ZIEL: Wir wollen unsere Erfahrung mit der roboterassistierten Refundoplicatio nach Nissen bei jugendlichen Patienten beschreiben, die als Kinder primär fundopliziert wurden. METHODEN:Das Video zeigt schrittweise die roboterassistierte Refundoplicatio mit dem Robotersystem Da Vinci Xi (Intuitive, Sunnyvale, CA, USA). Es handelt sich in unserer Serie um 3 Patienten, die im Alter von 15 ± 2 Jahren eine Refundoplicatio aufgrund von gastroösophagealem Reflux erhielten. Durchschnittlich 11,8 Jahre nach dem Primäreingriff zeigten sich pathologische Refluxsymptome, aufgrund derer die Indikation zur Refundoplicatio nach Nissen-Rosetti gestellt wurde. ERGEBNISSE UND DISKUSSION:Die 3-D-Visualisierung des Robotersystems bot dem Operateur bei der Präparation eine gute Übersicht im voroperierten Situs. Außerdem erlaubte sie eine präzise Dissektion der erwarteten Adhäsionen um den Hiatus. Die durchschnittliche Schnitt-Naht-Zeit der roboterassistierten Refundoplicatio betrug 174 min. Weder intra- noch postoperativ traten Komplikationen auf. Ähnlich wie bei dem Erlernen laparoskopischer Operationstechniken ist bei roboterassistierter Chirurgie eine Lernkurve vorhanden. Diesen Trend kann man anhand unserer Daten bereits nachvollziehen. Eine Verkürzung der Operationszeit und die einfachere Präparation könnte dementsprechend den erhöhten Materialeinsatz des Roboters aufwiegen. SCHLUSSFOLGERUNG:Die roboterassistierte Refundoplicatio ist eine ausgezeichnete Alternative zu konventionellen laparoskopischen Verfahren bei jungen Erwachsenen, die in früher Kindheit eine Fundoplicatio erhalten haben und erneut Refluxsymptome entwickeln. Die 3-D-Sicht und die multiaxiale Bewegungsfreiheit der Instrumente erleichtern die Präparation der Strukturen und Adhäsionen.
journal_name
Zentralbl Chirjournal_title
Zentralblatt fur Chirurgieauthors
Moursi AGA,Grimminger P,Rohleder S,Muensterer Odoi
10.1055/a-1137-0128subject
Has Abstractpub_date
2020-12-01 00:00:00pages
509-512issue
6eissn
0044-409Xissn
1438-9592journal_volume
145pub_type
杂志文章abstract::Nearly 200 clinical studies concerning perioperative antibiotic prophylaxis are compiled and evaluated by biometric methods, however without fulfilling the criteria of meta-analysis. Derived from its results it can be concluded, that this prophylaxis is indicated for the wound categories "clean" and "clean-contaminate...
journal_title:Zentralblatt fur Chirurgie
pub_type: 杂志文章,评审
doi:
更新日期:1991-01-01 00:00:00
abstract:BACKGROUND:To be able to evaluate properly a vascular problem, basic concepts of vascular physiology need to be considered, as they have been taught in physiology for a long time. This article deals with selected definitions and laws of passive vascular mechanics, subdivided into parameters of vascular filling and para...
journal_title:Zentralblatt fur Chirurgie
pub_type: 杂志文章,评审
doi:10.1055/s-0032-1327967
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abstract::During the past 10 years, postoperative mortality associated with resection of oesophageal carcinoma has been reduced from 30% to 11%. However, all efforts to improve longterm survival with extensive excisional procedures and adjuvant chemotherapy and radiotherapy have failed. Fifty-three of 100 patients presenting to...
journal_title:Zentralblatt fur Chirurgie
pub_type: 杂志文章,评审
doi:
更新日期:1992-01-01 00:00:00
abstract::The shortage of surgeons in the operative disciplines field has in recent years further increased. The training of a surgeon and the required lifestyle combined with the work-life balance of the surgeons are perceived as being less attractive, so that young doctors after finishing medical school rarely decide for surg...
journal_title:Zentralblatt fur Chirurgie
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doi:10.1055/s-0029-1224764
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abstract:BACKGROUND:Intra-abdominal hypertension (IAH) has a high prevalence among critically ill patients. It is increasingly recognised as a risk factor for poor outcome. PATIENTS / MATERIAL AND METHODS: A review of the literature including explicit management instructions was performed. We report the standardised techniques ...
journal_title:Zentralblatt fur Chirurgie
pub_type: 杂志文章,评审
doi:10.1055/s-0030-1262768
更新日期:2011-04-01 00:00:00
abstract::From 1966 to 1978, 122 infants and children suffering from injuries of the distal radial epiphysis were treated by reposition and repeated reposition. 68 of them were followed-up from 2 to 13 years later. In most cases spontaneous correction of remaining deformities by growth could be demonstrated. This remodelling of...
journal_title:Zentralblatt fur Chirurgie
pub_type: 杂志文章
doi:
更新日期:1985-01-01 00:00:00
abstract::Interruption of the inferior vena cava by an umbrella-filter, clip or Green-field-filter has been performed in more than 400 patients during the past 14 years. Overall hospital mortality was 1% by clip application and 7% by Mobin-Uddin-umbrella. The indication for this method is limited to those patients suffering fro...
journal_title:Zentralblatt fur Chirurgie
pub_type: 杂志文章
doi:
更新日期:1985-01-01 00:00:00
abstract::Missed abdominal injuries after blunt abdominal trauma belong to the most frequent causes of death, especially in polytraumatized patients. Primary missing these injuries often is a tragedy due to a mortality-rate up to 50% after delayed treatment compared with a low complication- and mortality-rate after diagnosis in...
journal_title:Zentralblatt fur Chirurgie
pub_type: 杂志文章,评审
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更新日期:1999-01-01 00:00:00
abstract::218 patients who underwent subintimal dissection were followed up over a period of 21/2 years. The results (72,6% patients at the end of 21/2 years) come up to those of the saphenous vein bypass. the rate of secondary amputations (7.21%) is low, the primary mortality rate comes up to 2.75%. In our opinion thrombendart...
journal_title:Zentralblatt fur Chirurgie
pub_type: 杂志文章
doi:
更新日期:1981-01-01 00:00:00
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journal_title:Zentralblatt fur Chirurgie
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journal_title:Zentralblatt fur Chirurgie
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journal_title:Zentralblatt fur Chirurgie
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doi:10.1055/s-2002-22026
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journal_title:Zentralblatt fur Chirurgie
pub_type: 杂志文章,评审
doi:10.1055/s-0029-1224607
更新日期:2009-09-01 00:00:00
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journal_title:Zentralblatt fur Chirurgie
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journal_title:Zentralblatt fur Chirurgie
pub_type: 杂志文章
doi:
更新日期:1977-01-01 00:00:00
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journal_title:Zentralblatt fur Chirurgie
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journal_title:Zentralblatt fur Chirurgie
pub_type: 杂志文章,评审
doi:10.1055/s-0030-1262755
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journal_title:Zentralblatt fur Chirurgie
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journal_title:Zentralblatt fur Chirurgie
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journal_title:Zentralblatt fur Chirurgie
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journal_title:Zentralblatt fur Chirurgie
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journal_title:Zentralblatt fur Chirurgie
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journal_title:Zentralblatt fur Chirurgie
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更新日期:1994-01-01 00:00:00
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journal_title:Zentralblatt fur Chirurgie
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journal_title:Zentralblatt fur Chirurgie
pub_type: 杂志文章,评审
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更新日期:1981-01-01 00:00:00
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journal_title:Zentralblatt fur Chirurgie
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journal_title:Zentralblatt fur Chirurgie
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journal_title:Zentralblatt fur Chirurgie
pub_type: 杂志文章,评审
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更新日期:1998-01-01 00:00:00
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journal_title:Zentralblatt fur Chirurgie
pub_type: 杂志文章
doi:
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