Description

The evolution of minimally invasive surgery has been significantly advanced by robotic technology, particularly in complex foregut procedures such as fundoplication, Heller’s myotomy, and hiatal hernia repair. These procedures are commonly performed to treat gastroesophageal reflux disease (GERD), achalasia cardia, and hiatal hernias, respectively. Robotic surgery offers enhanced precision, three-dimensional visualization, and superior ergonomics, allowing surgeons to perform these technically demanding operations with greater safety and consistency. Robotic fundoplication is primarily aimed at restoring the competence of the lower esophageal sphincter to prevent reflux. The step-by-step approach begins with patient positioning and port placement, followed by careful dissection of the esophageal hiatus. The robotic platform enables meticulous mobilization of the gastric fundus while preserving vital structures such as the vagus nerves. Once adequate esophageal length is achieved, the fundus is wrapped around the distal esophagus to create a tension-free and anatomically precise fundoplication, ensuring durable reflux control. Heller’s myotomy, the standard surgical treatment for achalasia, benefits greatly from robotic assistance. After exposure of the gastroesophageal junction, the circular muscle fibers of the esophagus and proximal stomach are divided with exceptional precision. The magnified robotic view allows the surgeon to clearly identify tissue planes, reducing the risk of mucosal perforation. This controlled, step-by-step muscle division effectively relieves functional obstruction and improves esophageal emptying. A partial fundoplication is often added to prevent postoperative reflux. Robotic hiatal hernia repair involves systematic reduction of the herniated stomach into the abdominal cavity, followed by complete excision of the hernia sac. The crura of the diaphragm are then approximated with sutures under direct robotic visualization, restoring normal anatomy of the esophageal hiatus. In large or recurrent hernias, mesh reinforcement may be used to enhance long-term durability. The robotic system facilitates accurate suturing in the confined mediastinal space, which is often challenging with conventional laparoscopy. In conclusion, a step-by-step robotic approach to fundoplication, Heller’s myotomy, and hiatal hernia repair represents a major advancement in foregut surgery. By combining precise dissection, improved visualization, and controlled suturing, robotic surgery enhances surgical outcomes while minimizing complications. These procedures exemplify how modern technology continues to refine surgical techniques and improve patient care in minimally invasive gastrointestinal surgery.