Kelly and John continue their hernia series with a practical discussion of hiatal and paraesophageal hernias for surgical first assistants, clarifying the four types (type I sliding vs types II–IV paraesophageal/giant) and why case details matter for preparation. They review key anatomy and risks near the hiatus (including aorta, pleura, vagus nerves, short gastrics) and emphasize reading the H&P, communicating with the surgeon, and anticipating equipment needs. John walks through major laparoscopic steps and common variations, including hernia sac reduction, mediastinal dissection, crural closure (EndoStitch vs swedged-on needle), bougie sizing, mesh options, Penrose for esophageal retraction, and Nissen vs Toupet fundoplication, plus complications like dysphagia, gas bloat, and pneumothorax. Kelly adds robotic setup considerations such as docking, port placement, AirSeal, instrument choices, and liver retraction options.

Robotic ApproachVideo by Dr. David Lourie:https://youtu.be/UfRGXkUY0ew?si=xAMjVgFa8Uzt95wg

Robotic approach (SAGES) by Caitlin Houghton

https://youtu.be/GbdQVAmRXro?si=XBzFY-kQCkHERqQV

Laparoscopic Approach:

https://youtu.be/7XmBH39KzcA?si=3JEHL42Vz7YDcQdx

https://youtu.be/4_ED29Dt-Bg?si=2yzxZSelMW8gQh6H

https://youtu.be/4_ED29Dt-Bg?si=USIUC5JT-4vn3g-x