{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T08:51:34Z","timestamp":1791967894627,"version":"4.3.4"},"reference-count":11,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T00:00:00Z","timestamp":1791763200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T00:00:00Z","timestamp":1791763200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Surg Endosc"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Tension-free crural closure is critical for durable hiatal hernia repair. Historically, quantifying crural closure tension (CCT) required workflow-disrupting external gauges. The da Vinci 5 (dV5) platform\u2019s integrated force feedback allows instantaneous, device-free tension monitoring. This study quantifies in vivo CCT during robotic hiatal hernia repair (RHHR) and introduces an exploratory metric, the Crural Stiffness Index (CSI), defined as peak force per centimeter of crural displacement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective cohort analysis evaluated 76 patients undergoing RHHR at a single institution by a single surgeon using the dV5 system with force feedback instruments between January 2024 and December 2025. Using a standardized tension measurement protocol (TMP), controlled traction was applied to approximate the crura while recording continuous force telemetry. Primary outcomes were mean force, peak force, and CSI during closure.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Mean hiatal defect width was 2.16 \u00b1 0.75\u00a0cm. Mean force within the calibrated measurement range (\u2264\u20096.5 N) (2.92 \u00b1 0.75 N) remained consistent regardless of defect size (\n                      <jats:italic>p<\/jats:italic>\n                      = 0.276). Peak force averaged 9.60 \u00b1 2.79 N, significantly correlating with defect width; large hernias (&gt;\u20092.0\u00a0cm) required higher tension than small hernias (10.38 vs. 8.78 N,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.011). The cohort\u2019s mean CSI was 6.09 \u00b1 2.12 N\/cm. CSI did not significantly differ between large and small defects (\n                      <jats:italic>p<\/jats:italic>\n                      = 0.888), suggesting intrinsic compliance is independent of initial hernia size.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Using the dV5 and a standardized TMP, this study reliably quantified, in vivo, CCT during robotic hiatal hernia repairs. While mean forces remained uniform, peak forces significantly increased with larger defect widths. CSI suggested that crural compliance may be independent of hernia size. As a proof of concept, crural tensiometry is feasible within standard robotic workflow. The exploratory CSI requires prospective validation against clinical outcomes before it can guide operative decisions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00464-026-13462-5","type":"journal-article","created":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T17:40:11Z","timestamp":1791826811000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Quantification of tension during cruroplasty of robotic-assisted hiatal hernia repairs using force feedback instruments on the da Vinci surgical platform (dV5)"],"prefix":"10.1007","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-8001-1646","authenticated-orcid":false,"given":"Khang","family":"Ngo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marzieh Ershad","family":"Langroodi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prakash","family":"Gatta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,10,12]]},"reference":[{"key":"13462_CR1","volume-title":"Gastrointestinal surgical emergencies textbook","author":"AE Aaron","year":"2021","unstructured":"Aaron AE, Amabile A, Andolfi C et al (2021) Gastrointestinal surgical emergencies textbook. American College of Surgeons, Chicago"},{"issue":"12","key":"13462_CR2","doi-asserted-by":"publisher","first-page":"4409","DOI":"10.1007\/s00464-013-3173-3","volume":"27","author":"GP Kohn","year":"2013","unstructured":"Kohn GP, Price RR, DeMeester SR et al (2013) Guidelines for the management of hiatal hernia. Surg Endosc 27(12):4409\u20134428. https:\/\/doi.org\/10.1007\/s00464-013-3173-3","journal-title":"Surg Endosc"},{"issue":"5","key":"13462_CR3","doi-asserted-by":"publisher","first-page":"429","DOI":"10.1097\/SLE.0b013e3182a12716","volume":"23","author":"SR DeMeester","year":"2013","unstructured":"DeMeester SR (2013) Laparoscopic paraesophageal hernia repair: critical steps and adjunct techniques to minimize recurrence. Surg Laparosc Endosc Percutan Tech 23(5):429\u2013435. https:\/\/doi.org\/10.1097\/SLE.0b013e3182a12716","journal-title":"Surg Laparosc Endosc Percutan Tech"},{"issue":"4","key":"13462_CR4","doi-asserted-by":"publisher","first-page":"796","DOI":"10.1007\/s00464-014-3744-y","volume":"29","author":"DD Bradley","year":"2015","unstructured":"Bradley DD, Louie BE, Farivar AS, Wilshire CL, Baik PU, Aye RW (2015) Assessment and reduction of diaphragmatic tension during hiatal hernia repair. Surg Endosc 29(4):796\u2013804. https:\/\/doi.org\/10.1007\/s00464-014-3744-y","journal-title":"Surg Endosc"},{"issue":"9","key":"13462_CR5","doi-asserted-by":"publisher","first-page":"3040","DOI":"10.1007\/s00464-019-06843-6","volume":"33","author":"L Navaratne","year":"2019","unstructured":"Navaratne L, Ashrafian H, Mart\u00ednez-Isla A (2019) Quantifying tension in tension-free hiatal hernia repair: a new intra-operative technique. Surg Endosc 33(9):3040\u20133049. https:\/\/doi.org\/10.1007\/s00464-019-06843-6","journal-title":"Surg Endosc"},{"issue":"1","key":"13462_CR6","doi-asserted-by":"publisher","DOI":"10.4293\/jsls.2015.00104","volume":"20","author":"CG Chang","year":"2016","unstructured":"Chang CG, Thackeray L (2016) Laparoscopic hiatal hernia repair in 221 patients: outcomes and experience. JSLS 20(1):e2015.00104. https:\/\/doi.org\/10.4293\/jsls.2015.00104","journal-title":"JSLS"},{"key":"13462_CR7","doi-asserted-by":"publisher","first-page":"9","DOI":"10.21037\/vats-21-31","volume":"7","author":"M Sudarshan","year":"2022","unstructured":"Sudarshan M, Raja S (2022) Re-operative surgery after paraesophageal hernia repair: narrative review. Video-Assist Thorac Surg 7:9. https:\/\/doi.org\/10.21037\/vats-21-31","journal-title":"Video-Assist Thorac Surg"},{"issue":"5","key":"13462_CR8","doi-asserted-by":"publisher","first-page":"1687","DOI":"10.1007\/s10029-024-03023-x","volume":"28","author":"T Panici Tonucci","year":"2024","unstructured":"Panici Tonucci T, Aiolfi A, Bona D, Bonavina L (2024) Does crural repair with biosynthetic mesh improve outcomes of revisional surgery for recurrent hiatal hernia? Hernia 28(5):1687\u20131695. https:\/\/doi.org\/10.1007\/s10029-024-03023-x","journal-title":"Hernia"},{"issue":"5","key":"13462_CR9","doi-asserted-by":"publisher","first-page":"1559","DOI":"10.1007\/s10029-024-03126-5","volume":"28","author":"I Karikis","year":"2024","unstructured":"Karikis I, Pachos N, Mela E et al (2024) Comparative analysis of robotic and laparoscopic techniques in hiatal hernia and crural repair: a review of current evidence and outcomes. Hernia 28(5):1559\u20131569. https:\/\/doi.org\/10.1007\/s10029-024-03126-5","journal-title":"Hernia"},{"issue":"5","key":"13462_CR10","doi-asserted-by":"publisher","first-page":"947","DOI":"10.1016\/j.athoracsur.2025.07.019","volume":"120","author":"A Bassiri","year":"2025","unstructured":"Bassiri A, Pawar OS, Boutros C et al (2025) Robotic vs laparoscopic hiatal hernia repair: a comparative study of short- and long-term surgical outcomes. Ann Thorac Surg 120(5):947\u2013956. https:\/\/doi.org\/10.1016\/j.athoracsur.2025.07.019","journal-title":"Ann Thorac Surg"},{"issue":"6","key":"13462_CR11","doi-asserted-by":"publisher","first-page":"907","DOI":"10.1007\/s00464-006-9043-5","volume":"21","author":"L Fei","year":"2007","unstructured":"Fei L, del Genio G, Brusciano L et al (2007) Crura ultrastructural alterations in patients with hiatal hernia: a pilot study. Surg Endosc 21(6):907\u2013911. https:\/\/doi.org\/10.1007\/s00464-006-9043-5","journal-title":"Surg Endosc"}],"container-title":["Surgical Endoscopy"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00464-026-13462-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00464-026-13462-5","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00464-026-13462-5.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T08:23:29Z","timestamp":1791966209000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00464-026-13462-5"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,12]]},"references-count":11,"alternative-id":["13462"],"URL":"https:\/\/doi.org\/10.1007\/s00464-026-13462-5","relation":{},"ISSN":["0930-2794","1432-2218"],"issn-type":[{"value":"0930-2794","type":"print"},{"value":"1432-2218","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,12]]},"assertion":[{"value":"1 May 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"22 September 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 October 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Marzieh Ershad Langroodi is a full-time employee of Intuitive Surgical, Inc. Prakash Gatta, MD is a consultant for Intuitive Surgical and BD Mesh. Khang Ngo has no conflicts of interest or financial ties to disclose.","order":1,"name":"Ethics","label":"Disclosures","group":{"name":"EthicsHeading","label":"Declarations"}}]}}