Comparison of laparoscopic vs. robotic paraesophageal hernia repair: a systematic review

Abstract

Background: In both clinical practice and residency training, the use of robotic platforms in surgery is becoming more common. The aim of this study was to perform a systematic review of the perioperative outcomes of robotic and laparoscopic paraesophageal hernia (PEH) repair. Methods:The PRISMA statement guidelines were used to perform this systematic review. We conducted a database search which included Ovid MEDLINE(R) and Epub Ahead of Print, In-Process & Other Non-Indexed Citations, and Daily, Ovid EMBASE, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews, and Scopus. There were 384 articles discovered in the initial search using various keywords. From those 384 articles, after duplicates were removed and publications were eliminated based on eligibility criteria, 7 publications were then chosen for analysis. Risk of bias was assessed using Cochrane Risk of Bias Assessment Tool. Narrative synthesis of results has been provided.Results: When compared to standard laparoscopic approaches, robotic surgery for large PEHs may offer benefits in terms of decreased conversion rate and shorter hospital stay. Some studies found a decrease in need for esophageal lengthening procedures and fewer long-term recurrences. The perioperative complication rate is similar between the two techniques in most studies; however, one large study of nearly 170,000 patients in the early years of robotics adoption demonstrated a higher rate of esophageal perforation and respiratory failure in the robotic group (2.2% increase in absolute risk). Cost is another disadvantage of robotic repair when compared to laparoscopic repair. Our study is limited by the non-randomized and retrospective nature of the studies.Conclusions: More studies into recurrence rates and long-term complications are needed to determine the efficacy of robotic versus laparoscopic PEHs repair.

Is the robotic revolution stunting surgical skills?

“…Several large hernia repair trials comparing robotics with laparoscopy, including the RIVAL trial at both 1 and 2 year follow-up as well as ventral hernia repair trials [ [3] , [4] , [5] , [6] , [7] ] have demonstrated equivalent clinical outcomes with added healthcare costs. The findings were similar in studies examining the use of robotics in bariatric surgery [ [8] , [9] , [10] , [11] ], foregut surgery [ 12 ], and colorectal surgery [ [13] , [14] , [15] , [16] ], with one recent study demonstrating increased risk of common bile duct injury during robotic cholecystectomy and questioning the safety of the robotic platform in this surgery [ 17 ]–a procedure increasingly performed using the robot. And, while these studies have focused on the clinical impact of robotics, other studies have demonstrated greater CO 2 emissions and worse environmental impact of robotic surgery when compared with laparoscopy [ 18 , 19 ].…”

The impact of robotic surgery on the treatment of benign esophageal and gastric disease. Early experience of a specialized unit

“…Reported operation time varies widely among different centers, although most studies present a signi cant decline as the learning curve grows. [30][31][32] Regarding postoperative symptom relief and quality of life, comparative studies indicated no statistically signi cant superiority for the robotic approach over the laparoscopic. [33][34][35][36][37] Functional examinations have been utilized in a number of prospective studies comparing laparoscopic to robotic approach.…”

“…[24] Data on robot-assisted hiatal hernia repair also show excellent results regarding safety and perioperative outcomes even in technically demanding cases [25][26][27][28]. Results regarding postoperative complications are currently inconclusive, as certain studies comparing the laparoscopic and robotic approaches for hiatal hernia repair present dominance of the robotic approach, while others report increased incidence of respiratory complications in patients who undergo robotic repair [29,30]. Reported operation time varies widely among different centers, although most studies present a signi cant decline as the learning curve grows.…”

Hérnia de Hiato - Aspectos epidemiológicos, fisiopatológicos e manejo terapêutico

“…A fisiopatologia da HH é baseada principalmente no gradiente de pressão transdiafragmático, no qual sofre ações de pressões positivas, advindo da cavidade abdominal e negativas, oriundas da cavidade torácica, resultando em uma força contínua para cima na JGE. Dessa forma, há violação do hiato esofágico através das diferenças de pressão entre as cavidades torácicas e abdominais, ocasionando o surgimento da HH (HÅKANSON et al, 2018;PETROV et al, 2019;SATHASIVAM et al, 2019;BHATT;WEI, 2023).…”