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Thoracic Surgery

Q&A Topic: Robotic Esophageal and Hiatal Hernia Surgery

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Tracey Weigel, MD, FACS, FACCP

Q: What is a hiatal hernia and how does it develop?

A: There are two main types of hiatal hernias: sliding and para-esophageal. A sliding hiatal hernia (HH) occurs when the gastroesophageal junction between esophagus and stomach slides up into the chest. This is the most common type of HH. The second major type is a para-esophageal hiatal hernia, which implies that the GE junction is in its normal abdominal location and part of stomach slides up through the diaphragmatic hiatus — the hole in the muscle that separates the chest and abdomen. The latter type can be very painful and even life-threatening if the stomach becomes strangulated. Hiatal hernias can be caused by factors that increase abdominal pressure such as straining, coughing and obesity, but some are likely congenital.

Q: What conditions might make someone a candidate for esophageal surgery?

A: Pain or bleeding with a known HH; diagnosis of a para-esophageal hernia; achalasia, a condition in which the sphincter at the bottom of the esophagus doesn’t relax; or the diagnosis of esophageal cancer. These can all lead to esophageal surgery.

Q: What are the benefits of utilizing robotics in these procedures?

A: Robotics have several advantages over conventional laparoscopic and thoracoscopic surgery. First, they enable the surgeon to have true 3D visibility that is magnified and in high-definition while doing laparoscopic surgery through tiny 8mm incisions. Second, they utilize instruments that articulate like human wrists to allow finer movements and the performance of more complex tasks.

Third, they give the surgeon, rather than an assistant, control of four instruments at once, which improves both precision and efficiency during operations. And fourth, utilizing the robot, a surgeon can change the scale of the robot’s arm motion relative to the surgeon’s actual motion, which reduces inaccuracies due to natural tremors in the human hand.

Q: What are some common patient concerns with robotic surgery, and how do you address them?

A: Probably the most common concern patients voice is that the robot will make a mistake. I have to explain to patients that the robot does not have artificial intelligence (AI). Rather, the robot is just an extremely precise high-tech instrument whose every movement is initiated and completely controlled by the surgeon.

Tracey Weigel, MD, FACS, FACCP
Westchester Medical Center, flagship of the Westchester Medical Center Health Network (WMCHealth)
Chief, Thoracic Surgery
100 Woods Road
Valhalla, NY 10595
914.493.8793
www.westchestermedicalcenter.com

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