Injury to the Spleen
- Prevention through subtle preparation
- Treatment through robotic hemostatic measures (coagulation, hemostatics) and splenectomy as a last resort
Esophageal/Stomach Wall Injury
- Prevention through subtle preparation
- Diagnosis possible through intraoperative blue test
Treatment by suturing the defect and ideally covering with the cuff - Possibly intraoperative endoscopic control
Pneumothorax
- Due to injury of the parietal pleura during mediastinal preparation
- Only significant in the presence of cardiopulmonary problems intraoperatively
- Initially inconsequential in a stable patient
- If ventilation pressure increases or oxygenation is poor, initially reduce intra-abdominal pressure and increase positive inspiratory pressure
- Possibly otherwise intraoperative thoracic drainage. Completion of the operation robotically with drainage in place
- At the end of the operation, good ventilation of the lungs through manual ventilation with open trocars
Bleeding
Short Gastric Arteries:
- Possible complication when transecting the short gastric arteries for gastric fundus mobilization
- Hemostasis can be challenging with poor exposure in severe visceral obesity.
Diaphragmatic Veins:
- In close proximity to the hiatus
- Hemostasis can also be challenging
Aorta:
- Runs behind the hiatus
- An injury is theoretically possible