Robotic foregut surgery

Robotic-assisted surgery for benign esophageal diseases is well described for the treatment of achalasia, gastroesophageal reflux, paraesophageal hernias, and revisional hiatal surgery. Robotic surgery has significant advantages in a narrow deep field like the mediastinum with the benefits of a stable camera platform, added length and wristed movements of the instruments, three-dimensional magnification, and tremor filtration, all of which lead to improved visualization, dexterity, and precision. A growing number of studies have shown benefits of robotic surgery in Heller myotomy with regard to decreased esophageal perforation rates and in complex revisional hiatal surgery with decrease in conversion and readmission rates. Its potential disadvantages include lack of haptic feedback as well as increased costs, which may be offset with advances in the learning curve leading to decreased operative times.