Efficacy and safety of robot-assisted versus conventional 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; clinical efficacy; safety; 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 hiatal hernia repair. Methods PubMed, 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 hiatal 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.

Citation： WANG Yaping, QUE Changhao, LI Keyong, YE Zhibo, JIN Dacheng, GOU Yunjiu. Efficacy and safety of robot-assisted versus conventional laparoscopy in hiatal hernia repair: A systematic review and meta-analysis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2026, 33(6): 957-963. doi: 10.7507/1007-4848.202404014 Copy

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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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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.
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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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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. 時占強, 張定, 馬超. 腹腔鏡食管裂孔疝修補聯合His角成形術治療胃食管反流病合并食管裂孔疝患者的效果. 醫學理論與實踐, 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, 郗洪慶. 達芬奇機器人疝手術與發展趨勢. 中華普外科手術學雜志(電子版), 2017, 11(1): 5-7.Tian W, Xi HQ. Trends in Da Vinci robotic surgery for hernia. 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. 達芬奇機器人輔助腹腔鏡與傳統腹腔鏡在食管裂孔疝修補術的療效分析. 南昌大學, 2020.Zhu P. Analysis of the efficiency of Da Vince robot-assisted laparoscopic and conventional laparoscopic in hiatal hernia repair. Nanchang University, 2020.
15. 黎鑫, 艾克拜爾·艾力, 阿力木江·麥斯依提, 等. 機器人輔助袖狀胃切除聯合胃底折疊治療肥胖癥合并食管裂孔疝的單中心回顧性分析. 中國普通外科雜志, 2022, 31(10): 1347-1354.Li X, Aikebaier·AL, Alimujiang·MSYT, et al. Robot-assisted synchronous sleeve gastrectomy and fundoplication surgery for obesity complicated with esophageal hiatal hernia: a single-center retrospective analysis. Chin J Gen Surg, 2022, 31(10): 1347-1354.
16. 亞力坤·吐爾洪. 機器人輔助腹腔鏡與傳統腹腔鏡食管裂孔疝修補聯合Nissen胃底折疊術的對比研究. 新疆醫科大學, 2023.Yalikun TEH. A comparative study of robot-assisted laparoscopic and traditional laparoscopic 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. 麥麥提艾力·麥麥提明, 多力坤·牙生, 伊爾夏提江·艾尼瓦爾, 等. 機器人和腹腔鏡食管裂孔疝修補術短期臨床療效回顧性隊列研究. 中華外科雜志, 2023, 61(6): 498-502.Memetaili MMTM, Duolikun YS, Yierxiatijiang ENWE, et al. Clinical effects of robot-assisted esophageal hiatal hernia repair and laparoscopic esophageal hiatal hernia repair: a retrospective comparative study. 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, 楊永彰, 常士民. 食管裂孔疝. 復旦學報(醫學版), 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, 郗洪慶, 衛勃, 等. 機器人輔助食管裂孔疝修補術及胃底折疊術2例報告及文獻復習. 中國實用外科雜志, 2015, 35(5): 519-521.Tian W, Xi HQ, Wei B, et al. Robotic-assisted repair of esophageal hiatal hernia combined with fundoplication: a report of two cases. 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, 江志鵬, 李英儒, 等. 食管裂孔疝及胃食管反流性疾病腹腔鏡下規范化七步法手術操作指南(2021版). 嶺南現代臨床外科, 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.
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Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Efficacy and safety of robot-assisted versus conventional laparoscopy in hiatal hernia repair: A systematic review and meta-analysis

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