Minimally invasive robotic Nissen fundoplication.

Two Nissen fundoplications were performed by a minimally invasive robotic t echnique on May 19, 1998. The,Mona robot, was placed to the left of the pat ient. It held and activated surgical tools. The surgeon was placed some 3 m eters from the patient and was seated at a console. Hr was nor scrubbed. He commanded the 3 robotic arms by manipulating two handles, while observing a 3 dimensional picture recreated by a binocular system. Manipulations of t he handles mwere translated into digital information by a computer. This in formation was modified by the computer with downscaling of the amplitude of motion by a Factor 1 to 3 or 1 to 5. Physiologic tremor was eliminated. Th e computer delivered an impulse in command of the articulated robot arms vi a a 5 m long cable. Operating time was 4.30 hours, and 1.30 hours respectiv ely. Blood loss was estimated at 20 and 30 mt. The two patients were discha rged on the first postoperative day after a gastrograffin swallow had been performed in order to check the position of the wrap and its patency. Our e xperience with the Mona device may suggest that surgical robotics could hav e an increasingly important role in tomorrow's operating theatres. It shoul d allow for more precise procedures, performed under better circumstances.