IPEG 2020 TOP ABSTRACT: First Laparoscopic Pediatric Nissen Fundoplication using the Human Xtensions Handheld Software-driven...
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The demanding steps in pediatric Nissen fundoplication are the creation of the retroesophageal space and the hiatoplasty.
The Human Xtensions Hand-Ax system offers the advantages of robotic surgery to overcome the drawbacks of straight instruments in modern laparoscopy.
The Hand-Ax system is a handheld fully articulating 5 millimeter software-driven laparoscopic platform.
The patient was a 12-year-old neurologically impaired patient suffering from gastroesophageal reflux disease, presenting with histologically confirmed esophagitis with confluent ulcers in the distal esophagus.
This video exhibits the first time use of the Hand-Ax system in pediatric anti-reflux surgery.
Dense adhesions were present due to chronic inflammation of the esophagus.
The angulation of the Hand-Ax instrument allows mobilization of the retroesophageal space and a controlled passage of the instrument behind the esophagus.
The hiatoplasty is challenging with conventional instruments, especially in small children and infants.
The angulation of the Hand-Ax instrument can be locked at any angle.
The locked instrument can be used to push the esophagus aside to ease the stitch on the left crus.
The instrument stays locked to grasp the needle after the passage through the right crus.
The articulating tip is used to perform intracorporeal knots.
The formation of the 360 degree Nissen wrap should include the esophagus.
The angulation of the instrument allows the needle to follow a 90 degree angle to the desired plane of tissue.
The passage of the needle through the muscularis of the esophagus is controlled without any tension.
This platform overcomes the disadvantages of a straight instrument.
The instrument is locked in the desired position, the needle is picked up in the correct angle, and only the tip is rotated to perform a controlled stitch.