{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T12:27:10Z","timestamp":1793622430884,"version":"4.5.0"},"reference-count":26,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T00:00:00Z","timestamp":1789948800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:p>Antireflux surgery may be required in patients with spinal muscular atrophy type 2 (SMA2), but disease-specific experience is limited. To our knowledge, we report the first robot-assisted Nissen fundoplication in SMA2. A 23-year-old woman with severe gastroesophageal reflux disease, bulbar dysfunction, impaired secretion management, severe restrictive respiratory impairment, a previous failed intubation, and fixed musculoskeletal deformities was referred for surgery. Multidisciplinary planning led to fibreoptic nasotracheal intubation under deep sevoflurane sedation and topical anaesthesia, preserving spontaneous ventilation. Intubation was achieved on the first attempt without desaturation or haemodynamic instability. Robot-assisted Nissen fundoplication with Mikulicz pyloroplasty was completed using adapted positioning and port placement. Robotic liver retraction and suction through a 10-Fr nasogastric tube introduced via a robotic port avoided additional access. Positioning required 30\u2005min, operative time was 110\u2005min, including 65\u2005min of console time, and total procedural time from the start of positioning to skin closure was 140\u2005min. After complete neuromuscular recovery, the patient was extubated 2\u2005h 43\u2005min after surgery directly onto non-invasive ventilation. No complications occurred, and she was discharged on postoperative day 5. At 1 month, contrast imaging confirmed the absence of reflux and satisfactory gastric emptying. At a 4-month multidisciplinary clinical assessment, she reported no reflux-related symptoms and improved management of salivary secretions during ongoing follow-up with our logopedists. Robot-assisted Nissen fundoplication in SMA2 is feasible in expert hands when supported by tailored anaesthetic and surgical planning.<\/jats:p>","DOI":"10.3389\/fsurg.2026.1964655","type":"journal-article","created":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T05:36:00Z","timestamp":1789968960000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: Robot-assisted nissen fundoplication in spinal muscular atrophy type 2\u2014a tailored surgical and anaesthetic strategy"],"prefix":"10.3389","volume":"13","author":[{"given":"Michela Cing Yu","family":"Wong","sequence":"first","affiliation":[{"name":"Department of Pediatric Surgery, IRCCS Istituto Giannina Gaslini","place":["Genoa, Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Agamennone","sequence":"additional","affiliation":[{"name":"Department of Pediatric Surgery, IRCCS Istituto Giannina 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