Colin G. Knight, M.D.; Kelly M. Gidell, R.N., B.S.N.; Attila Lorincz, M.D.; Scott E. Langenburg, M.D.; Michael D. Klein, M.D.

The Maxine and Stuart Frankel Foundation Computer-Assisted Robot-Enhanced Surgery Program at Children's Hospital of Michigan, Detroit, Michigan, U.S.A.

Case Report: Two children (3 year-old, 10.2 kg and 6 year-old, 21.6 kg) diagnosed with Morgagni hernia after chest roentgenogram underwent robot-enhanced laparoscopic repair of their hernias. After placing four, 5 mm trocars into the peritoneum, standard laparoscopic graspers were used to reduce the hernia contents. In one case a standard laparoscopic grasper and hook cautery were used to dissect the edge of the hernia free from the liver. In the other case, robot enhanced instruments (Zeus Microwrist System grasper and hook cautery) were used for the dissection. Robot-enhanced instruments were used to place and tie suture in order to close the hernia defects. Both cases were successfully completed laparoscopically. The robotic system took 9 minutes to set up and drape. The average operative time was 217 minutes. The robotic system performed without malfunction and the surgeon noted the relative ease of placing and tying sutures under tension in an enclosed space. Both hernias were closed without a patch. The surgeon felt that he had better control when dissecting the liver when using the robot-enhanced system. The older child tolerated oral intake the day of surgery and was discharged to home on the first post-operative day. The younger child tolerated oral intake on the second post-operative day and was discharged to home on the second post-operative day.

Discussion: Robot-enhanced surgery enhances laparoscopic surgery through motion scaling, tremor filtration, improved ergonomics, and the addition of a wrist at the distal end of the instruments. The enhancements of robotic surgery can make complex laparoscopic procedures, such as those described here, easier to perform. The surgeon found it relatively easy to place and tie suture under tension in these cases, allowing the defects to be closed without any patch. He also found he has greater precision in dissecting the hernia when using the robotic instruments. We are the first group to report using robotic technology for laparoscopic repair of Morgagni hernias in children.



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