Learning Curve in Two-Port Laparoscopic Gastropexy Using FlexDex

Simple Summary: Some large-breed dogs are at high risk of a life-threatening gastric dilatation and volvulus (GDV) when the stomach twists and cuts off the blood supply. This must be treated surgically with gastropexy. Gastropexy can be also performed before GDV occurs through open surgery or laparoscopically (keyhole). Laparoscopic gastropexy can be performed in various ways, and one of the newer trends is the use of semi-robotic instruments, such as the FlexDex device (Infiniti Medical, Brighton (US). This paper reports on a learning curve of a specialist surgeon with prior expertise starting to use the FlexDex device. Because this novel tool offers great range of movement, laparoscopic suturing is much easier with it, and within 12 cases, the operating time dropped by 73%, from 52 to 14 min. This is significant because many surgeons shy away from keyhole procedures due to the lengthy time to gain sufficient skills. Reducing surgical time also represents shorter, therefore, safer anaesthesia as well as lower costs of anaesthetic drugs and agents. Using advanced instruments decreases the technical difficulties related with keyhole surgery and laparoscopic suturing in particular. Objectives: Keyhole gastropexy is becoming increasingly popular, and the new development facilitates shorter surgical times. This paper reports on the learning curve in two-port laparoscopic gastropexy using FlexDex in a specialist's hands. FlexDex is a novel tool combining aspects of robotic surgery without requiring an expensive robot theatre setting. Methods: Cohort of 16 dogs >25 kg and at high risk of gastric volvulus and dilatation (GDV) undergoing elective laparoscopic gastropexy were enrolled in the study consecutively from 5/2022 to 9/2023. All patients were operated on by one surgeon (FM), and surgical time was recorded to assess learning curve. Competence was defined as plateauing surgical time. Detailed follow-up at 1 day, 7 days, 14 days, 2 months, 6 months, and long-term was recorded for success rate and complications. Ultrasound examination was scheduled at 4-6-month review to confirm lasting success of the gastropexy. Results: All 16 patients were operated on successfully without any significant complications, as confirmed on the ultrasound. The surgical time of laparoscopic gastropexy reduced from 52 to 14 min (reduction of 38 min/73%) and reached plateau after the 12th case of the 16, making it a very steep learning curve in specialist hands. There were no serious complications, and success rate was 100% at the 6-month ultrasound assessment. Clinical Significance: This is the first paper to report on the learning curve with the FlexDex device in a two-port laparoscopic gastropexy setting. It effectively halves the operating time to 30 min, making the surgery safer for the patient and more cost-efficient, without compromising the result.