Measuring Tension During Robotic Hiatal Hernia Repair Crural Closure with Force-Feedback Instruments on the da Vinci dV5 Platform

By
Khang Ngo
Marzieh Ershad Langroodi
Prakash Gatta
October 12, 2026

Surgical Endoscopy

Overview

This proof-of-concept study examines whether crural closure tension (CCT) and an exploratory Crural Stiffness Index (CSI) can be quantified during robotic hiatal hernia repair using force-feedback instruments on the da Vinci 5 platform. Force measurements were retrospectively obtained from system logs and were not available to the surgeon during the operations; the supplied material does not report patient numbers or study results.

Background

Hiatal hernias include sliding hernias and paraesophageal hernias (types II–IV), with type III the predominant paraesophageal subtype. Surgical repair is generally used for paraesophageal hernias when symptoms remain refractory to medical management. Tension-free crural closure is considered important to repair durability, while excessive tension and weakened crural tissue may contribute to suture pull-through and recurrence. Existing intraoperative assessment of crural compliance is subjective, and earlier force-gauge studies were limited by workflow interruption and inability to provide continuous measurement.

Data Highlights

The supplied article material describes the study objective and methods context but provides no patient count, measured CCT or CSI values, or study outcomes. Prior force-gauge studies cited in the context reported tension reductions of 35.8% after left pleurotomy, 46.2% after right crural relaxing incision, and 56.1% after both; another study concluded that suture cruroplasty is permissible when CCT is below 4 N.

Key Findings

The study aims to establish the feasibility of quantifying CCT and CSI during robotic crural closure using the da Vinci 5 platform.
CSI is described as an exploratory measure defined as peak force per centimeter of crural displacement.
Force measurements were retrospectively obtained from system logs and were unavailable to the surgeon during the study operations.
The study period preceded availability of a real-time intraoperative force display on the platform.
Earlier force-gauge research reported CCT reductions of 35.8% with left pleurotomy, 46.2% with a right crural relaxing incision, and 56.1% with both techniques.
Navaratne et al. concluded that suture cruroplasty is permissible when CCT is below 4 N; the supplied material does not provide results from the present study.

Clinical Implications

The source presents integrated force measurement as a potential means of objectively characterizing crural closure during robotic repair, but this study is described as an initial feasibility step rather than clinical validation or decision support. The source identifies possible future investigation of whether force information could inform considerations such as mesh use or relaxing incisions; it does not establish clinical thresholds or treatment recommendations.

Conclusion

The study addresses the feasibility of measuring crural closure forces and an exploratory stiffness index during robotic hiatal hernia repair. The supplied material does not report results sufficient to establish clinical validity or guide intraoperative decisions.