IPEG 2020 TOP ABSTRACT: First Laparoscopic Pediatric Nissen Fundoplication using the Human Xtensions Handheld Software-driven...

Thank you for the opportunity to show a new laparoscopic platform in pediatric funduplication. The authors have nothing to disclose. The demanding steps in pediatric Nissen fund duplication are the creation of the retroesophageal space and the hyatoplasty. The human extension 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 new handheld fully articulating 5 millimeter software-driven laparoscopic platform. We present a Nissenf application performed in 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. One of the initial steps is the dissection of the right and left crews. In this case with dense adhesions due to chronic inflammation of the esophagus. The angle of his is mobilized. One of the key steps is the creation of the retroesophageal space. The hand ax is brought into the abdominal cavity from the patient's left side. The angulation of the instrument allows mobilization of the retoesophageal space and a controlled passage of the instrument behind. The esophagus. The hyatoplasty is challenging with conventional instruments, especially in small children and infants. The angulation of the 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 cruise. The instrument stays locked to grasp the needle after the passage through the right cross. The articulating tip is used to perform intercorporal knots as usual. The instrument is also helpful in picking up the loose end of the suture. The slipping knot is tight but without a loose end in between. The hyatoplasty is completed. The formation of the 360 degree Nissan wrap should include the esophagus. The fundus has been already stitched on the patient's left side. 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. The posterior fundus is grasped and pulled through the re esophageal window. This platform overcomes the disadvantages of a straight instrument. You can see its full range of motion. 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. The 360 degree font application is completed via the final sliding knot.