Case Report: Robot-assisted nissen fundoplication in spinal muscular atrophy type 2-a tailored surgical and anaesthetic strategy.

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 min, operative time was 110 min, including 65 min of console time, and total procedural time from the start of positioning to skin closure was 140 min. After complete neuromuscular recovery, the patient was extubated 2 h 43 min 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.