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. 2023 Sep 15;26(3):134-145.
doi: 10.7602/jmis.2023.26.3.134.

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

Symeonidou Elissavet  1 , Gkoutziotis Ioannis  1 , Petras Panagiotis  1 , Mpallas Konstantinos  1 , Kamparoudis Apostolos  1
Affiliations

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

Symeonidou Elissavet et al. J Minim Invasive Surg. .

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.

Keywords: Hiatal hernia; Laparoscopy; Mesh; Paraesophageal; Robotics.

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Conflict of interest statement

Conflict of interest

All authors have no conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
Flow chart of the search strategy algorithm and the data extraction according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines.
Fig. 2
Fig. 2
Forest plots. (A) Meta-analysis of overall postoperative complication rates [–5,7,8,22]. (B) Meta-analysis of length of stay [,,–10,22,27,28]. (C) Meta-analysis of mean operation time [4,5,7,9,10,27].
Fig. 3
Fig. 3
Funnel plots. (A) Meta-analysis of overall postoperative complication rates [–5,7,8,22]. (B) Meta-analysis of length of stay [,,–10,22,27,28]. (C) Meta-analysis of mean operation time [4,5,7,9,10,27].
Fig. 4
Fig. 4
Meta-analysis of mean operation time after conducting a sensitivity analysis. (A) Forest plot. (B) Funnel plot.
See this image and copyright information in PMC

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