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Quantification of tension during cruroplasty of robotic-assisted hiatal hernia repairs using force feedback
Khang Ngo1, Marzieh Ershad Langroodi2, Prakash Gatta3
1University of North Texas Health Science Center - TCOM, Fort Worth, TX, USA. khangngo98@gmail.com.
Background:
Tension-free crural closure is critical for durable hiatal hernia repair. Historically, quantifying crural closure tension (CCT) required workflow-disrupting external gauges. The da Vinci 5 (dV5) platform's integrated force feedback allows instantaneous, device-free tension monitoring. This study quantifies in vivo CCT during robotic hiatal hernia repair (RHHR) and introduces an exploratory metric, the Crural Stiffness Index (CSI), defined as peak force per centimeter of crural displacement.
Methods:
A retrospective cohort analysis evaluated 76 patients undergoing RHHR at a single institution by a single surgeon using the dV5 system with force feedback instruments between January 2024 and December 2025. Using a standardized tension measurement protocol (TMP), controlled traction was applied to approximate the crura while recording continuous force telemetry. Primary outcomes were mean force, peak force, and CSI during closure.
Results:
Mean hiatal defect width was 2.16 ± 0.75 cm. Mean force within the calibrated measurement range (≤ 6.5 N) (2.92 ± 0.75 N) remained consistent regardless of defect size (p = 0.276). Peak force averaged 9.60 ± 2.79 N, significantly correlating with defect width; large hernias (> 2.0 cm) required higher tension than small hernias (10.38 vs. 8.78 N, p = 0.011). The cohort's mean CSI was 6.09 ± 2.12 N/cm. CSI did not significantly differ between large and small defects (p = 0.888), suggesting intrinsic compliance is independent of initial hernia size.
Conclusions:
Using the dV5 and a standardized TMP, this study reliably quantified, in vivo, CCT during robotic hiatal hernia repairs. While mean forces remained uniform, peak forces significantly increased with larger defect widths. CSI suggested that crural compliance may be independent of hernia size. As a proof of concept, crural tensiometry is feasible within standard robotic workflow. The exploratory CSI requires prospective validation against clinical outcomes before it can guide operative decisions.
