To share and discuss the surgical safety and clinical experience of the robotic "3+1" mode in hiatal hernia repair.

This study was a single-center retrospective case series. A total of 145 patients who underwent da Vinci robot-assisted laparoscopic hiatal hernia repair in the Department of Minimally Invasive, Hernia and Abdominal Wall Surgery, People's Hospital of Xinjiang Uygur Autonomous Region, from January 2022 to January 2025 were included. All patients underwent trocar placement using the "3+1" mode, and the operations were completed accordingly. Postoperative improvement, hernia recurrence, and complications were followed up through outpatient appointments, online consultations, and telephone calls. The follow-up deadline was December 2025.

All 145 patients successfully underwent robot-assisted laparoscopic hiatal hernia repair combined with fundoplication, without conversion to open abdominal or thoracic surgery. Among them, 137 patients underwent Nissen fundoplication, 2 underwent Dor fundoplication, and 6 underwent Toupet fundoplication. The mean hernia defect area was (47.5±17.3) cm², the mean operative time was (67.5±18.8) min, the mean intraoperative blood loss was (15.0±5.0) ml, the mean postoperative hospital stay was (6.5±2.5) days, and the mean surgical cost was RMB (6.8±1.0)×10⁴ yuan. The mean postoperative follow-up duration was (30.5±7.5) months. Postoperative symptoms such as acid reflux, heartburn, and chest pain were markedly improved compared with those before surgery. During follow-up, no pleural effusion, pulmonary infection, wound infection, or recurrence was observed.

Robot-assisted hiatal hernia repair using the robotic "3+1" mode has high surgical safety. The trocar placement method is simple, standardized, highly reproducible, and highly operable.