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Updated: Jul 19, 2026
Robotic Myotomy and Partial Fundoplication for Achalasia
Published on: August 11, 2023
Robotic fundoplication in children
Magnus Anderberg1, Christina Clementson Kockum, Einar Arnbjörnsson
1Department of Paediatric Surgery, University Hospital, 221 85, Lund, Sweden. magnus.anderberg@skane.se
Insights
Robot-assisted surgery for pediatric fundoplication shows comparable outcomes to standard laparoscopic procedures. While initial operating times were longer, robotic surgery offers enhanced visualization and precision, improving the surgical experience.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Surgical Robotics
Background:
- Fundoplication is a surgical procedure to treat gastroesophageal reflux in children.
- Minimally invasive laparoscopic techniques have been adopted since 2006.
- The da Vinci Surgical System represents a novel robotic approach for this procedure.
Purpose of the Study:
- To compare robot-assisted laparoscopic fundoplication with open and standard laparoscopic techniques in pediatric patients.
- To evaluate key outcomes including operating time, analgesic use, hospital stay, and short-term clinical results.
Main Methods:
- Prospective inclusion of six pediatric patients undergoing robot-assisted laparoscopic fundoplication.
- Retrospective selection of six control patients for open surgery and six for standard laparoscopic surgery.
- Comparison of demographic data, De Meester scores, operating time, postoperative analgesia, hospital stay, and clinical outcomes.
Main Results:
- No significant differences in age, weight, or preoperative pH measurements among the three groups.
- Initial longer operating time in the robotic group, but comparable to laparoscopic by the fourth patient.
- Shorter postoperative hospital stay and reduced analgesic use in the robotic group, similar to benefits seen with standard laparoscopy.
Conclusions:
- Robot-assisted laparoscopic fundoplication is a viable alternative, demonstrating comparable short-term clinical outcomes to standard laparoscopy.
- Robotic surgery offers enhanced surgeon visualization and instrument precision.
- The benefits of reduced hospital stay and analgesic use are consistent with minimally invasive approaches.
Abstract:
Since January 2006, robotic assistance has been used for performing minimal invasive laparoscopic fundoplications in children. These patients were compared with those operated on with either the open surgical technique or the laparoscopic procedure. The first six children operated on with a fundoplication using the operation robot, da Vinci Surgical System from Intuitive Surgical, were included prospectively. As controls, data from the latest six children operated on using the open surgical procedure and the latest six children operated on using the minimal invasive laparoscopic technique were selected retrospectively. All the patients were operated on due to gastroesophageal reflux and were comparable in the De Meester score. The main outcome measures were the operating time, the use of postoperative analgesics, the duration of the postoperative hospital stay and the short-term outcome. There was no significant difference between the three groups concerning age, body weight and preoperative 24 h pH measurement. The mean operating time for the robotic group, 213 min, was the longer one, but the operating time for the latest four patients in the robotic group was similar to that for the laparoscopic group, 189 min. The postoperative hospital stay was shorter and a reduction in the use of analgesics postoperatively was noted. The reduction in the postoperative hospital stay and in the use of analgesics had been already noted with the introduction of the minimal invasive laparoscopic technique. There was no difference in short-term clinical outcome; the gastroesophageal reflux symptoms disappeared in all the patients. Robot-assisted laparoscopic fundoplication is comparable with the standard laparoscopic surgical procedure in terms of duration of operation, postoperative hospital stay, use of postoperative analgesics and short-term clinical outcome. The robotic surgery adds qualities to the surgical work when compared with open or laparoscopic surgery. These include better visualisation for the surgeon and greater precision in the movements of the instruments used.
