Robotic-assisted versus laparoscopic paraesophageal hernia repair: a systematic review and meta-analysis

Abstract

Purpose The robotic approach offers improved visualization and maneuverability for surgeons. This systematic review aims to compare the outcomes of robotic-assisted and conventional laparoscopic approaches for paraesophageal hernia repair, specifically examining postoperative complications, operative time, hospital stay, and recurrence. Methods A systematic review including thorough research through PubMed, Scopus, and Cochrane, was performed and only comparative studies were included. Studies concerning other types of hiatal hernias or children were excluded. A meta-analysis was conducted to compare overall postoperative complications, hospital stay, and operation time. Results Ten comparative studies, with 186,259 participants in total, were included in the meta-analysis, but unfortunately, not all of them reported all the outcomes under question. It appeared that there is no statistically significant difference between the conventional laparoscopic and the robotic-assisted approach, regarding the overall postoperative complication rate (odds ratio [OR], 0.56, 95% confidence interval [CI], 0.28–1.11), the mean operation time (t = 1.41; 95% CI, –0.15–0.52; p = 0.22), and the hospital length of stay (t = –1.54; degree of freedom = 8; 95% CI, –0.53–0.11; p = 0.16). Only two studies reported evidence concerning the recurrence rates. Conclusion Overall, the robotic-assisted method did not demonstrate superiority over conventional laparoscopic paraesophageal hiatal hernia repair in terms of postoperative complications, operation time, or hospital stay. However, some studies focused on cost and patient characteristics of each group. Further comparative and randomized control studies with longer follow-up periods are needed for more accurate conclusions on short- and long-term outcomes.

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

“…[19] A population-based analysis revealed that even in high-volume centers, average length of stay is shorter with the robotic approach although average cost Is elevated. [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].…”