Comparison between robotic Nissen, Toupet and Dor fundoplication: Results

Minimally invasive surgery has gained a role in the treatment of gastroesophageal reflux disease (GERD). Robotic fundoplication is one of choice of treatment in minimally invasive surgical managements. As for conventional and laparoscopic approaches, Nissen, Toupet and Dor are the mainly performed techniques of fundoplication with the robotic surgery. They differ in wrap construction both for the grades and for the anterior or posterior rotation. Some authors compared the three techniques in laparoscopic field in terms of symptoms control, failure of treatment and reintervention rate. We aimed to attempt a comparison between the three techniques performed by a robotic-assisted approach. The available literature on robotic fundoplication and relative different techniques is still low scarce. Except for intrinsic technical characteristics, the three techniques do not show particular differences between them. Total fundoplication seems to better control the GERD symptoms but has a higher rate of postoperative dysphagia than partial ones. Nissen fundoplication (NF) is the most practiced, standardized and described since its early employments. The lack of specific investigations about robotic Toupet fundoplication (TF) and Dor fundoplication (DF) with relative data preclude to compare the three mentioned techniques accurately. Although robotic surgery had proper characteristics, we could consider it as an advanced laparoscopic approach and thus we could liken the available data concerning the three laparoscopic fundoplication techniques to the corresponding robotic ones.