Totally endoscopic Nissen fundoplication with a robotic system in a child

The Da Vinci robot device represents the latest advance in laparoendoscopic surgery. We report the case of an endoscopic Nissen fundoplication performed with the aid of a telemanipulation robot system in a 10-year-old girl. To our knowledge, this is the first such case to be reported. In addition to standard monitoring, we used invasive blood pressure monitoring during the 282-min period of general anesthesia. Arterial blood gas samples were analyzed at short intervals. During surgery, which included a 172-min period of intraperitoneal insufflation of carbon dioxide (CO2), no significant changes were observed in PH, arterial oxygen pressure (PaO2), arterial carbon dioxide pressure (PaCO2), heart rate, or mean arterial pressure. Body temperature was maintained with an external warming blanket. Total intravenous anesthesia with continously administered propofol, remifentanil, and mivacurium for continous muscle relaxation allowed extubation immediately after skin closure. The girl was discharged from hospital on postoperative day 6. Robot-assisted techniques have the potential to significantly improve the performance of laparoendoscopic surgery. However, despite our encouraging first results, the potential risks of robot-assisted surgery have not yet been definitively established. Therefore, patients submitted to this type of procedure require intensive and even invasive monitoring.