Clinical Report: Robotic vs Laparoscopic Surgery for Anti-Reflux and Hiatal Hernia

Overview

This systematic review and meta-analysis compares short-term outcomes and costs between robotic-assisted surgery (RS) and laparoscopic surgery (LS) for anti-reflux and hiatal hernia procedures. The study synthesizes recent observational data to evaluate operative efficacy, safety, and economic impact, providing evidence to guide surgical approach decisions.

Background

Gastroesophageal reflux disease (GERD) and hiatal hernias are commonly treated with minimally invasive surgery, with laparoscopic surgery (LS) established as the standard due to reduced postoperative pain and faster recovery. Robotic-assisted surgery (RS) offers enhanced visualization and dexterity, potentially improving surgical precision in complex cases. Despite these technical advantages, RS adoption is limited by concerns about cost-effectiveness and insufficient evidence demonstrating superior clinical outcomes compared to LS. This analysis aims to clarify these issues by reviewing recent comparative studies.

Data Highlights

The meta-analysis included observational clinical studies published from 2013 to 2023 comparing RS and LS in patients undergoing curative surgery for GERD and/or hiatal hernia. Data extracted encompassed operative time, intraoperative complications, conversion rates, length of hospital stay, readmission, overall complications, mortality, and costs. Quality assessment was performed using the MINORS checklist. Statistical analysis employed odds ratios and mean differences with random effects models to account for study heterogeneity.

Key Findings

• Robotic-assisted surgery demonstrated improved three-dimensional visualization and dexterity, potentially facilitating complex dissections and suturing in anti-reflux and hiatal hernia repairs.
• Laparoscopic surgery remains the standard approach with established benefits of reduced postoperative discomfort and shorter hospital stays.
• Operative times and costs were key comparative metrics, with RS generally associated with higher costs but variable operative durations.
• Short-term outcomes including intraoperative complications, conversion to open surgery, readmission rates, and mortality showed no definitive superiority of RS over LS.
• The quality of included studies was assessed using the MINORS tool, highlighting the need for further high-quality randomized trials.

Clinical Implications

Surgeons should weigh the technical advantages of robotic-assisted surgery against its higher costs when selecting the surgical approach for GERD and hiatal hernia repair. While RS may offer ergonomic and visualization benefits, current evidence does not conclusively demonstrate improved short-term clinical outcomes compared to laparoscopic surgery. Decision-making should consider surgeon expertise, patient-specific factors, and institutional resources.

Conclusion

Robotic-assisted and laparoscopic surgeries both provide effective minimally invasive options for anti-reflux and hiatal hernia repair, with no clear superiority in short-term outcomes. Cost considerations and surgical expertise remain pivotal in approach selection, underscoring the need for further rigorous studies to define the optimal surgical strategy.

References

1. Slim et al. 2003 -- Methodological Index for Non-Randomized Studies (MINORS)
2. Wan et al. -- Method for Estimating Mean and Standard Deviation from Median and Range
3. PRISMA Guidelines -- Preferred Reporting Items for Systematic Reviews and Meta-Analyses