Robotic Morgagni hernia repair: an emerging approach to a congenital defect

Morgagni hernia (MH) is a rare, congenital diaphragmatic hernia (CDH). The use of robotic surgery to repair MH in adults has recently been described in the literature, but only on two previous occasions. The objective of this report is to describe four cases of robotic repair of MH in adults performed by a single surgeon to better delineate an emerging approach to this rare condition. A retrospective review of patients who underwent robotic repair of MH by a single surgeon was performed. Four consecutive patients were identified and included. The median age of patients was 43 (range: 23-70). All patients had symptoms prior to diagnosis, including substernal chest pain (n = 3), dyspnea (n = 4), dysphagia (n = 1), and regurgitation (n = 1). All patients underwent hernia reduction, primary tissue repair, and mesh implant with minimal average estimated blood loss. All hernias were right sided, and the average length of surgery was 129.8 min. The average length of stay was 2 days. No intraoperative complications or 30-day postoperative complications were reported. Symptoms, including chest pain and dyspnea, resolved postoperatively for each patient. With this technique, robotic Morgagni hernia repair can be done with short operative time, few complications, and favorable length of stay. This operation takes advantage of the dexterity and wristed nature of the instruments; suturing of the diaphragmatic defect and mesh (performed on the "ceiling" of field) and incorporating pledgets into these sutures become straightforward endeavors when performed robotically. We have found the robotic platform useful for a transabdominal approach to Morgagni hernia repair.