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

At a Glance

Key Highlights

• The study assessed the feasibility of quantifying crural closure tension and an exploratory Crural Stiffness Index during robotic repair.
• The cohort included 76 analyzed patients with symptomatic sliding or paraesophageal hernias; 32 additional cases were excluded for data or measurement limitations.
• Force measurements were retrospectively obtained from system logs and were not available to the surgeon during the operations.
• The Crural Stiffness Index was defined as peak force per centimeter of crural displacement.
• The work is described as proof of concept, preceding clinical validation, outcome prediction, and intraoperative decision support.

Guideline-Based Recommendations

Diagnosis

Management

• The article states that paraesophageal hernias are generally treated surgically when symptoms remain refractory to medical management.
• The article describes primary suture cruroplasty, suture or mesh reinforcement, bridging mesh repair, diaphragmatic relaxing incisions, and procedures to lengthen the esophagus.

Monitoring & Follow-up

• The study recorded hernia defect width, crural displacement, and peak and mean force during closure.
• Force measurements were retrospectively obtained from dV5 system logs and were unavailable to surgeons during the study period.

Risks

• The article describes excessive closure tension in attenuated crura as a concern because it may contribute to suture pull-through and recurrence.
• The article states that crural compliance is assessed subjectively through visual examination and tactile feedback.

Patient & Prescribing Data

Retrospective analysis of 76 patients with symptomatic sliding or paraesophageal hernias who underwent primary or revisional robotic-assisted repair at one institution between January 2024 and December 2025; 32 of 108 measured cases were excluded.

Surgeon-selected adjuncts, including mesh reinforcement or relaxing incisions, were based on operative findings. Force measurements were not available to guide intraoperative decisions.

Clinical Best Practices

• The study standardized operative technique and the tension-measurement protocol, including placement of the initial slip-knot stitch.
• The study was retrospective, conducted at one institution by one surgeon, and did not standardize anesthesia depth and paralysis.
• The article presents force measurement and the Crural Stiffness Index as subjects for further research, not as validated decision thresholds.

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