Robotic Partial Fundoplication and Hiatal Hernia Repair

The da Vinci surgical robot is increasingly applied as a clinically safe technique in the surgical treatment of large paraesophageal hernias. Robotic-assisted repair of large and recurrent hiatal hernias remains a technically demanding procedure and consists of some challenging key steps. A successful robotic-assisted (para)esophageal hernia repair should be performed according to the following three principles: (1) complete reduction of the stomach and hernia sac with extensive mediastinal dissection to optimize esophageal length, (2) primary closure of the crus using nonabsorbable sutures, and (3) the addition of a fundoplication. The emphasis of this chapter lies on these specific key steps. Furthermore we would like to emphasize the importance of a dedicated surgical team. Understanding the robotic system and necessary steps during this procedure provides proper positioning, optimal surgical exposure, and workflow and increases efficiency.