Evaluation of da Vinci Nissen Fundoplication clinical results and cost minimization

Background. A new technical tool was developed and introduced into the therapeutic field of videoscopic surgery-robotic telemanipulation surgery. The aim of this study is to investigate in a prospective randomized trial the feasibility of the Nissen procedure using the da Vinci and to evaluate the benefits and the costs of this new technique compared with the conventional laparoscopic approach. Materials and methods: Twenty patients with gastro-esophageal reflux disease (GERD) were randomized into laparoscopic Nissen versus robot-assisted Nissen fundoplication. All the patients signed an informed consent document. The time data of the procedure, the efficacy of the instruments, the intra-operative incidents, postoperative morbidity, and cost minimization are presented. Results: Nine patients were assigned to the robot, and 11 to the laparoscopic procedure. Both groups were similar in age, male/female ratio, and body mass index. The robot procedure time was significantly longer. The hospital stay and the alimentation day were similar. The number of postoperative complaints was similar after the 1st, 6th, and 12th postoperative months. However, on the 3rd postoperative month, the number of complaints was significantly higher in the robot group. The robot procedure was more expensive with regard to the instrumentation and reusable material, the nursing costs, the investment costs, and the maintenance costs. Conclusions: No clear advantage of using robotics in the Nissen procedure was observed. The procedure seems to be feasible and safe. The technique is limited because of unadapted instruments. The disadvantages are the high costs and prolonged operative time.