{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T06:10:10Z","timestamp":1756361410107,"version":"3.44.0"},"reference-count":27,"publisher":"BMJ","issue":"1","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2023,12,24]]},"published-print":{"date-parts":[[2024,1]]},"abstract":"<jats:p>Upper gastrointestinal perforation is a feared complication of diagnostic and therapeutic endoscopy, with an incidence of perforation between 0.3% and 5%. Even though is rare, the mortality rate can be as high as 40%. Currently, there is no consensus on the best therapeutic strategy and it usually depends on patient stability, the extent of perforation, time to diagnosis, surgeon experience and available resources<\/jats:p>\n               <jats:p>We present a case of a patient who presented to our institution to undergo an ambulatory oesophageal dilation. After dilation, the patient developed two full-thickness gastric perforations and a full-thickness oesophageal perforation without haemodynamic instability. All perforations were diagnosed and treated with a combination of intraoperative endoscopy and robotic surgery with excellent outcomes.<\/jats:p>\n               <jats:p>We demonstrate that a robotic approach combined with intraoperative diagnostic endoscopy is a safe and feasible treatment option for esophageal and gastric perforations in a stable patient without large extraluminal contamination.<\/jats:p>","DOI":"10.1136\/bcr-2023-258060","type":"journal-article","created":{"date-parts":[[2024,1,12]],"date-time":"2024-01-12T13:06:18Z","timestamp":1705064778000},"page":"e258060","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Robotic surgery in the management of synchronous esophageal and gastric perforation after endoscopic dilation"],"prefix":"10.1136","volume":"17","author":[{"given":"Maria Jose","family":"Donado Jimenez","sequence":"first","affiliation":[{"name":"Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria Carolina","family":"Jimenez","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert","family":"Cubas","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2024,1,12]]},"reference":[{"key":"2025082722460157000_17.1.e258060.1","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1007\/s11938-017-0117-3","article-title":"Endoscopic management of esophageal perforations: who, when, and how?","volume":"15","author":"Saxena","year":"2017","journal-title":"Curr Treat Options Gastroenterol"},{"key":"2025082722460157000_17.1.e258060.2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1572-0241.1999.01062.x"},{"key":"2025082722460157000_17.1.e258060.3","doi-asserted-by":"crossref","first-page":"684","DOI":"10.1177\/000313481808400520","article-title":"Management of esophageal perforation: 28-year experience in a major referral center","volume":"84","author":"Puerta Vicente","year":"2018","journal-title":"Am Surg"},{"key":"2025082722460157000_17.1.e258060.4","doi-asserted-by":"crossref","first-page":"496","DOI":"10.5606\/tgkdc.dergisi.2018.15354","article-title":"Minimally invasive management of esophageal perforation","volume":"26","author":"Ero\u011flu","year":"2018","journal-title":"Turk Gogus Kalp Damar Cerrahisi Derg"},{"key":"2025082722460157000_17.1.e258060.5","doi-asserted-by":"crossref","first-page":"2252","DOI":"10.1016\/j.cgh.2021.06.045","article-title":"AGA clinical practice update on endoscopic management of perforations in gastrointestinal tract","volume":"19","author":"Lee","year":"2021","journal-title":"Clin Gastroenterol Hepatol"},{"key":"2025082722460157000_17.1.e258060.6","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1177\/1457496916654097","article-title":"Predictors of morbidity and mortality in esophageal perforation: retrospective study of 80 patients","volume":"106","author":"Zimmermann","year":"2017","journal-title":"Scand J Surg"},{"key":"2025082722460157000_17.1.e258060.7","doi-asserted-by":"crossref","DOI":"10.1136\/bcr-2019-232392","article-title":"Pneumoperitoneum from acute gastric dilation and perforation","volume":"12","author":"Azevedo","year":"2019","journal-title":"BMJ Case Rep"},{"key":"2025082722460157000_17.1.e258060.8","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1177\/0218492319827439","article-title":"Surgical management of esophageal perforation: role of primary closure","volume":"27","author":"Huu Vinh","year":"2019","journal-title":"Asian Cardiovasc Thorac Ann"},{"key":"2025082722460157000_17.1.e258060.9","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1186\/s12876-019-1139-1","article-title":"Clinical outcomes of iatrogenic upper gastrointestinal endoscopic perforation: a 10-year study","volume":"19","author":"Kang","year":"2019","journal-title":"BMC Gastroenterol"},{"key":"2025082722460157000_17.1.e258060.10","unstructured":"Cameron JL . Current surgical therapy 13th edition. St. Louis, MO: Elsevier, 2019."},{"key":"2025082722460157000_17.1.e258060.11","doi-asserted-by":"crossref","unstructured":"Axtell AL , Gaissert HA , Morse CR , et al . Management and outcomes of esophageal perforation. 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