Efficacy and safety of robot-assisted versus traditional laparoscopy in hiatal hernia repair: A systematic review and meta-analysis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WANG Yaping ^1,2 , QUE Changhao ^1,2 , LI Keyong ^1,2 , YE Zhibo ^1,2 , JIN Dacheng ² ,  GOU Yunjiu ²

1. Gansu University of Chinese Medicine, Lanzhou, 730000, P. R. China;
2. Gansu Clinical Medical Research Center for Thoracic Diseases, Lanzhou, 730000, P. R. China;

Corresponding author：

GOU Yunjiu, Email: gouyunjiu@163.com

Keywords：

Hiatal hernia; robot-assisted laparoscopic surgery; conventional laparoscopic surgery; systematic review/meta-analysis

DOI：

10.7507/1007-4848.202404014

Video：

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Objective To systematically evaluate the efficacy and safety of robot-assisted laparoscopic surgery (RAS) and conventional laparoscopic surgery (CLS) in hiatus hernia repair. Methods PubMed, The Cochrane Library, CNKI, Web of Science, VIP, and Wanfang databases were searched to collect literature comparing the efficacy and safety of RAS and CLS for hiatus hernia repair published from their inception to November 7, 2023. The Newcastle-Ottawa Scale (NOS) was used to evaluate the quality of the included studies, and RevMan 5.4.1 software was used for meta-analysis. Results A total of 15 retrospective cohort studies with 18239 patients were finally included. The NOS scores of the included literature were all≥7 points. Meta-analysis results showed that RAS was superior to CLS in terms of postoperative complications as the primary outcome [OR=0.56, 95%CI (0.42, 0.77), P<0.01]. There was no statistical difference between the two methods in terms of average operation time [MD=−0.74, 95%CI (−12.99, 11.51), P=0.91], average intraoperative blood loss [MD=−24.47, 95%CI (−54.80, 5.87), P=0.11], intraoperative complications [OR=0.76, 95%CI (0.29, 2.01), P=0.58], average postoperative hospital stay [MD=−0.24, 95%CI (−0.75, 0.27), P=0.36], postoperative GERD score [MD=−0.04, 95%CI (−0.41, 0.33), P=0.81], and 30-day readmission rate [OR=0.60, 95%CI (0.30, 1.20), P=0.15]. The cost of CLS surgery was less than that of RAS [SMD=1.59, 95%CI (1.16, 2.01), P<0.01]. Conclusion RAS has comparable efficacy and safety to CLS in hiatus hernia repair.

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2.	Morrow EH, Chen J, Patel R, et al. Watchful waiting versus elective repair for asymptomatic and minimally symptomatic paraesophageal hernias: A cost-effectiveness analysis. Am J Surg, 2018, 216(4): 760-763.
3.	McLaren PJ, Hart KD, Hunter JG, et al. Paraesophageal hernia repair outcomes using minimally invasive approaches. JAMA Surg, 2017, 152(12): 1176-1178.
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5.	O'Rourke RW, Khajanchee YS, Urbach DR, et al. Extended transmediastinal dissection: An alternative to gastroplasty for short esophagus. Arch Surg, 2003, 138(7): 735-740.
6.	Supe AN, Kulkarni GV, Supe PA. Ergonomics in laparoscopic surgery. J Minim Access Surg, 2010, 6(2): 31-36.
7.	Braumann C, Jacobi CA, Menenakos C, et al. Robotic-assisted laparoscopic and thoracoscopic surgery with the da Vinci system: A 4-year experience in a single institution. Surg Laparosc Endosc Percutan Tech, 2008, 18(3): 260-266.
8.	田文, 郗洪庆. 达芬奇机器人疝手术与发展趋势. 中华普外科手术学杂志(电子版), 2017, 11(1): 5-7.Tian W, Xi HQ. The robotic surgery of hernia with the da Vinci system and its development trends. Chin J Oper Proced Gen Surg (Electron Ed), 2017, 11(1): 5-7.
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18.	Tjeerdsma M, Quinn KR, Helmer SD, et al. Comparing outcomes of robotic-assisted versus conventional laparoscopic hiatal hernia repair. Kans J Med, 2022, 15: 365-368.
19.	麦麦提艾力·麦麦提明, 多力坤·牙生, 伊尔夏提江·艾尼瓦尔, 等. 机器人和腹腔镜食管裂孔疝修补术短期临床疗效回顾性队列研究. 中华外科杂志, 2023, 61(6): 498-502.Memetaili·MMTM, Duolikun·YS, Yierxiatijiang·ENWE, et al. Retrospective cohort study on short-term clinical outcomes of robot-assisted and laparoscopic hiatal hernia repair. Chin J Surg, 2023, 61(6): 498-502.
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23.	Benedix F, Adolf D, Peglow S, et al. Short-term outcome after robot-assisted hiatal hernia and anti-reflux surgery: Is there a benefit for the patient? Langenbecks Arch Surg, 2021, 406(5): 1387-1395.
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25.	Hosein S, Carlson T, Flores L, et al. Minimally invasive approach to hiatal hernia repair is superior to open, even in the emergent setting: A large national database analysis. Surg Endosc, 2021, 35(1): 423-428.
26.	O'Connor SC, Mallard M, Desai SS, et al. Robotic versus laparoscopic approach to hiatal hernia repair: Results after 7 years of robotic experience. Am Surg, 2020, 86(9): 1083-1087.
27.	Lekarczyk A, Sinha H, Dvir D, et al. Similar hospital profits with robotic-assisted paraesophageal hiatal hernia repair, despite higher or supply costs. Surg Endosc, 2023, 37(5): 3952-3955.
28.	Kulshrestha S, Janjua HM, Bunn C, et al. State-level examination of clinical outcomes and costs for robotic and laparoscopic approach to diaphragmatic hernia repair. J Am Coll Surg, 2021, 233(1): 9-19.
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34.	食管裂孔疝焦点问题专家微共识第一次讨论. 中华疝和腹壁外科杂志(电子版), 2021, 15(5): 447.First discussion on the expert microconsensus for focus issues of hiatal hernia. Chin J Hernia Abdom Wall Surg (Electron Ed), 2021, 15(5): 447.
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1. Neo EL, Zingg U, Devitt PG, et al. Learning curve for laparoscopic repair of very large hiatal hernia. Surg Endosc, 2011, 25(6): 1775-1782.
2. Morrow EH, Chen J, Patel R, et al. Watchful waiting versus elective repair for asymptomatic and minimally symptomatic paraesophageal hernias: A cost-effectiveness analysis. Am J Surg, 2018, 216(4): 760-763.
3. McLaren PJ, Hart KD, Hunter JG, et al. Paraesophageal hernia repair outcomes using minimally invasive approaches. JAMA Surg, 2017, 152(12): 1176-1178.
4. 时占强, 张定, 马超. 腹腔镜食管裂孔疝修补联合His角成形术治疗胃食管反流病合并食管裂孔疝患者的效果. 医学理论与实践, 2023, 36(20): 3466-3468.Shi ZQ, Zhang D, Ma C. The effect of laparoscopic esophageal hiatus hernia repair combined with His angle plasty in the treatment of patients with gastroesophageal reflux disease complicated with esophageal hiatus hernia. J Med Theory Pract, 2023, 36(20): 3466-3468.
5. O'Rourke RW, Khajanchee YS, Urbach DR, et al. Extended transmediastinal dissection: An alternative to gastroplasty for short esophagus. Arch Surg, 2003, 138(7): 735-740.
6. Supe AN, Kulkarni GV, Supe PA. Ergonomics in laparoscopic surgery. J Minim Access Surg, 2010, 6(2): 31-36.
7. Braumann C, Jacobi CA, Menenakos C, et al. Robotic-assisted laparoscopic and thoracoscopic surgery with the da Vinci system: A 4-year experience in a single institution. Surg Laparosc Endosc Percutan Tech, 2008, 18(3): 260-266.
8. 田文, 郗洪庆. 达芬奇机器人疝手术与发展趋势. 中华普外科手术学杂志(电子版), 2017, 11(1): 5-7.Tian W, Xi HQ. The robotic surgery of hernia with the da Vinci system and its development trends. Chin J Oper Proced Gen Surg (Electron Ed), 2017, 11(1): 5-7.
9. Joo J, Kim J, Lee J. Effect of continuous systemic administration of esmolol on intraocular pressure during surgery in a sustained steep trendelenburg position. J Glaucoma, 2017, 26(12): 1068-1071.
10. Zhang Y, Han Y, Gan Q, et al. Early outcomes of robot-assisted versus thoracoscopic-assisted Ivor Lewis esophagectomy for esophageal cancer: A propensity score-matched study. Ann Surg Oncol, 2019, 26(5): 1284-1291.
11. Elissavet S, Ioannis G, Panagiotis P, et al. Robotic-assisted versus laparoscopic paraesophageal hernia repair: A systematic review and meta-analysis. J Minim Invasive Surg, 2023, 26(3): 134-145.
12. Ma L, Luo H, Kou S, et al. Robotic versus laparoscopic surgery for hiatal hernia repair: A systematic literature review and meta-analysis. J Robot Surg, 2023, 17(5): 1879-1890.
13. Stang A. Critical evaluation of the Newcastle-Ottawa scale for the assessment of the quality of nonrandomized studies in meta-analyses. Eur J Epidemiol, 2010, 25(9): 603-605.
14. 朱萍. 达芬奇机器人辅助腹腔镜与传统腹腔镜在食管裂孔疝修补术的疗效分析. 南昌大学, 2020.Zhu P. Therapeutic effect analysis of da vinci robot-assisted laparoscopic and traditional laparoscopic hiatal hernia repair. Nanchang University, 2020.
15. 黎鑫, 艾克拜尔·艾力, 阿力木江·麦斯依提, 等. 机器人辅助袖状胃切除联合胃底折叠治疗肥胖症合并食管裂孔疝的单中心回顾性分析. 中国普通外科杂志, 2022, 31(10): 1347-1354.Li X, Aikebaier·AL, Alimujiang·MSYT, et al. A Single-center Retrospective Analysis of Robot-assisted Sleeve Gastrectomy Combined with Fundoplication for the Treatment of Obesity with Hiatal Hernia. Chin J Gen Surg, 2022, 31(10): 1347-1354.
16. 亚力坤·吐尔洪. 机器人辅助腹腔镜与传统腹腔镜食管裂孔疝修补联合Nissen胃底折叠术的对比研究. 新疆医科大学, 2023.Yalikun·TEH. A comparative study of robot-assisted laparoscopic versus traditional laparoscopic esophageal hiatal hernia repair combined with Nissen fundoplication. Xinjiang Medical University, 2023.
17. Wilhelm A, Nocera F, Schneider R, et al. Robot-assisted vs. laparoscopic repair of complete upside-down stomach hiatal hernia (the RATHER-study): A prospective comparative single center study. Surg Endosc, 2022, 36(1): 480-488.
18. Tjeerdsma M, Quinn KR, Helmer SD, et al. Comparing outcomes of robotic-assisted versus conventional laparoscopic hiatal hernia repair. Kans J Med, 2022, 15: 365-368.
19. 麦麦提艾力·麦麦提明, 多力坤·牙生, 伊尔夏提江·艾尼瓦尔, 等. 机器人和腹腔镜食管裂孔疝修补术短期临床疗效回顾性队列研究. 中华外科杂志, 2023, 61(6): 498-502.Memetaili·MMTM, Duolikun·YS, Yierxiatijiang·ENWE, et al. Retrospective cohort study on short-term clinical outcomes of robot-assisted and laparoscopic hiatal hernia repair. Chin J Surg, 2023, 61(6): 498-502.
20. Gerull WD, Cho D, Arefanian S, et al. Favorable peri-operative outcomes observed in paraesophageal hernia repair with robotic approach. Surg Endosc, 2021, 35(6): 3085-3089.
21. Gehrig T, Mehrabi A, Fischer L, et al. Robotic-assisted paraesophageal hernia repair: A case-control study. Langenbecks Arch Surg, 2013, 398(5): 691-696.
22. Soliman BG, Nguyen DT, Chan EY, et al. Robot-assisted hiatal hernia repair demonstrates favorable short-term outcomes compared to laparoscopic hiatal hernia repair. Surg Endosc, 2020, 34(6): 2495-2502.
23. Benedix F, Adolf D, Peglow S, et al. Short-term outcome after robot-assisted hiatal hernia and anti-reflux surgery: Is there a benefit for the patient? Langenbecks Arch Surg, 2021, 406(5): 1387-1395.
24. Howell RS, Liu HH, Petrone P, et al. Short-term outcomes in patients undergoing paraesophageal hiatal hernia repair. Sci Rep, 2020, 10(1): 7366.
25. Hosein S, Carlson T, Flores L, et al. Minimally invasive approach to hiatal hernia repair is superior to open, even in the emergent setting: A large national database analysis. Surg Endosc, 2021, 35(1): 423-428.
26. O'Connor SC, Mallard M, Desai SS, et al. Robotic versus laparoscopic approach to hiatal hernia repair: Results after 7 years of robotic experience. Am Surg, 2020, 86(9): 1083-1087.
27. Lekarczyk A, Sinha H, Dvir D, et al. Similar hospital profits with robotic-assisted paraesophageal hiatal hernia repair, despite higher or supply costs. Surg Endosc, 2023, 37(5): 3952-3955.
28. Kulshrestha S, Janjua HM, Bunn C, et al. State-level examination of clinical outcomes and costs for robotic and laparoscopic approach to diaphragmatic hernia repair. J Am Coll Surg, 2021, 233(1): 9-19.
29. 凌宏琛, 杨永彰, 常士民. 食管裂孔疝. 复旦学报(医学版), 1964(4): 370-373, 386.Ling HC, Yang YZ, Chang SM. Hiatal hernia. Fudan Univ J Med Sci, 1964(4): 370-373, 386.
30. 田文, 郗洪庆, 卫勃, 等. 机器人辅助食管裂孔疝修补术及胃底折叠术2例报告及文献复习. 中国实用外科杂志, 2015, 35(5): 519-521.Tian W, Xi HQ, Wei B, et al. Two case reports and literature review of robot-assisted hiatal hernia repair and fundoplication. Chin J Pract Surg, 2015, 35(5): 519-521.
31. Banki F, Weaver M, Roife D, et al. Laparoscopic reoperative antireflux surgery is more cost-effective than open approach. J Am Coll Surg, 2017, 225(2): 235-242.
32. Chan EG, Sarkaria IS, Luketich JD, et al. Laparoscopic approach to paraesophageal hernia repair. Thorac Surg Clin, 2019, 29(4): 395-403.
33. 周太成, 江志鹏, 李英儒, 等食管裂孔疝及胃食管反流性疾病腹腔镜下规范化七步法手术操作指南(2021版). 岭南现代临床外科, 2021, 21(5): 500-506.Zhou TC, Jiang ZP, Li YR, et al. Laparoscopic standardized seven-step surgical operation guide for hiatal hernia and gastroesophageal reflux disease (2021 edition). Lingnan J Mod Clin Surg, 2021, 21(5): 500-506.
34. 食管裂孔疝焦点问题专家微共识第一次讨论. 中华疝和腹壁外科杂志(电子版), 2021, 15(5): 447.First discussion on the expert microconsensus for focus issues of hiatal hernia. Chin J Hernia Abdom Wall Surg (Electron Ed), 2021, 15(5): 447.
35. Zehetner J, Demeester SR, Ayazi S, et al. Laparoscopic versus open repair of paraesophageal hernia: The second decade. J Am Coll Surg, 2011, 212(5): 813-820.
36. Laan DV, Agzarian J, Harmsen WS, et al. A comparison between Belsey Mark Ⅳ and laparoscopic Nissen fundoplication in patients with large paraesophageal hernia. J Thorac Cardiovasc Surg, 2018, 156(1): 418-428.
37. Bhatt H, Wei B. Comparison of laparoscopic vs. robotic paraesophageal hernia repair: A systematic review. J Thorac Dis, 2023, 15(3): 1494-1502.
38. Pelzner K, Mueller DT, Fuchs C, et al. Robot-assisted repair of hiatal hernia: Advantages and disadvantages in comparison to conventional laparoscopic repair: A literature review. Int J Abdom Wall Hernia Surg, 2023, 6(2): 77-80.
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Latest ArticlesEfficacy and safety of robot-assisted versus traditional laparoscopy in hiatal hernia repair: A systematic review and meta-analysis

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