Novel Fluorescence-Guided Gastric Calibration Tube in Robotic Paraesophageal Hernia Repair.
- 1Department of Surgery, North Shore University Hospital, Zucker School of Medicine at Hofstra/Northwell, Manhasset, New York, USA. (Dr. Fontaine-Nicola).
- 2Department of Surgery, West Virginia University, Morgantown, West Virginia, USA. (Drs. Harman, Hajjar, and Szoka).
- 3Department of Surgery, University of California, San Diego, California, USA. (Dr. Reyes).
Abstract
Background
Fluorescence-guided (FG) surgery using near-infrared imaging has been adopted to enhance intraoperative visualization in multiple surgical fields. In foregut surgery, calibration tubes are routinely used to calibrate crural closure but due to limited visibility carry a risk of iatrogenic injury, including esophageal or gastric perforation. Techniques that improve visualization of these devices may support safer intraoperative management.Case presentation
A 75-year-old woman with a symptomatic paraesophageal hiatal hernia and partial gastric volvulus underwent robotic paraesophageal hiatal hernia repair with Toupet fundoplication. A FG gastric calibration tube (size 40 Fr, Endolumik Inc.), was inserted under near-infrared visualization and advanced down the esophagus and into the stomach. The device was used to (1) evacuate gastric contents, (2) guide tube positioning past the gastroesophageal junction, (3) inform mediastinal dissection/esophageal mobilization, (4) enable FG measuring of the length of esophageal mobilization below the diaphragm, and (5) calibrate both crural closure and fundoplication. The procedure was completed without intraoperative complications. The patient was discharged on postoperative day 1 and reported resolution of dysphagia at 8-week follow-up.Discussion
This case demonstrates the feasibility of FG calibration during robotic paraesophageal hernia repair. Continuous visualization of the calibration device provided an additional intraoperative reference during dissection in the setting of distorted anatomy. This approach may offer improved orientation compared with conventional calibration techniques, although its effect on clinical outcomes remains unknown.
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BibTeX
@article{fontainenicola2026novel,
title = {{Novel Fluorescence-Guided Gastric Calibration Tube in Robotic Paraesophageal Hernia Repair.}},
author = {Andres Fontaine-Nicola and Hayley Harman and Edgardo Reyes and Mustafa Hajjar and Nova Szoka},
journal = {CRSLS : MIS case reports from SLS},
year = {2026},
month = oct,
doi = {10.4293/crsls.2026.00069},
url = {https://europepmc.org/article/MED/42948756},
note = {CC BY-NC-SA},
}
RIS
TY - JOUR
TI - Novel Fluorescence-Guided Gastric Calibration Tube in Robotic Paraesophageal Hernia Repair.
AU - Andres Fontaine-Nicola
AU - Hayley Harman
AU - Edgardo Reyes
AU - Mustafa Hajjar
AU - Nova Szoka
PY - 2026
DA - 2026/10/27
JO - CRSLS : MIS case reports from SLS
DO - 10.4293/crsls.2026.00069
UR - https://europepmc.org/article/MED/42948756
AB - Background Fluorescence-guided (FG) surgery using near-infrared imaging has been adopted to enhance intraoperative visualization in multiple surgical fields. In foregut surgery, calibration tubes are routinely used to calibrate crural closure but due to limited visibility carry a risk of iatrogenic injury, including esophageal or gastric perforation. Techniques that improve visualization of these devices may support safer intraoperative management.Case presentation A 75-year-old woman with a symptomatic paraesophageal hiatal hernia and partial gastric volvulus underwent robotic paraesophageal hiatal hernia repair with Toupet fundoplication. A FG gastric calibration tube (size 40 Fr, Endolumik Inc.), was inserted under near-infrared visualization and advanced down the esophagus and into the stomach. The device was used to (1) evacuate gastric contents, (2) guide tube positioning past the gastroesophageal junction, (3) inform mediastinal dissection/esophageal mobilization, (4) enable FG measuring of the length of esophageal mobilization below the diaphragm, and (5) calibrate both crural closure and fundoplication. The procedure was completed without intraoperative complications. The patient was discharged on postoperative day 1 and reported resolution of dysphagia at 8-week follow-up.Discussion This case demonstrates the feasibility of FG calibration during robotic paraesophageal hernia repair. Continuous visualization of the calibration device provided an additional intraoperative reference during dissection in the setting of distorted anatomy. This approach may offer improved orientation compared with conventional calibration techniques, although its effect on clinical outcomes remains unknown.
SN - 2376-9254
ER -