Robotic-assisted reoperative benign foregut surgery

Foregut disorders including gastroesophageal reflux disease (GERD), hiatal hernia (HH), and achalasia are often treated operatively including anti-reflux surgery (ARS), fundoplication, and Heller myotomy (HM). Minimally invasive surgery has become the preferred technique to treat these disorders. These operations have an inherent risk of failure requiring reoperation. These redo operations are more difficult because adhesions and destruction of tissue planes impair visualization during dissection of the hiatus and the gastroesophageal junction (GEJ). Conventional laparoscopic techniques have been described for redo foregut surgery with good results. Surgical robotic systems provide an alternative minimally invasive approach that improves visualization, dexterity, and surgeon ergonomics in many operations. The robot can be used safely and effectively for redo foregut surgery. In this review, we discuss the robotic surgical technique for reoperative foregut surgery and discuss the approach to individual foregut diseases.