Robotics vs Laparoscopy in Foregut Surgery: Systematic Review and Meta-Analysis Analyzing Hiatal Hernia Repair and Heller Myotomy

Sabrina Awshah; Rahul Mhaskar; Abdul-Rahman Fadi Diab; Meagan Read; Emily Coughlin; Samer Ganam; Adham R Saad; Joseph Sujka; Christopher DuCoin

doi:10.1097/XCS.0000000000001074

Robotics vs Laparoscopy in Foregut Surgery: Systematic Review and Meta-Analysis Analyzing Hiatal Hernia Repair and Heller Myotomy

J Am Coll Surg. 2024 Mar 15. doi: 10.1097/XCS.0000000000001074. Online ahead of print.

Authors

Sabrina Awshah¹, Rahul Mhaskar^{1

2}, Abdul-Rahman Fadi Diab³, Meagan Read³, Emily Coughlin^{1

2}, Samer Ganam³, Adham R Saad^{1

3}, Joseph Sujka^{1

3}, Christopher DuCoin^{1

3}

Affiliations

¹ University of South Florida Morsani College of Medicine, Tampa, FL.
² Department of Medical Education, University of South Florida Morsani College of Medicine, Tampa, FL.
³ Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, FL.

PMID: 38497555
DOI: 10.1097/XCS.0000000000001074

Abstract

Background: Laparoscopic surgery remains the mainstay of treating foregut pathologies. Several studies have shown improved outcomes with the robotic approach. A systematic review and meta-analysis comparing outcomes of robotic and laparoscopic hiatal hernia repairs (HHR) and Heller myotomy (HM) repairs is needed.

Study design: PubMed, Embase and Scopus databases were searched for studies published between January 2010 and November 2022. The risk of bias was assessed using the Cochrane ROBINS-I tool. Assessed outcomes included intra- and post-operative outcomes. We pooled the dichotomous data using the Mantel-Haenszel random effects model to report odds ratio (OR) and 95% confidence intervals (95% CIs) and continuous data to report mean difference (MD) and 95% CIs.

Results: Twenty-two comparative studies enrolling 196,339 patients were included. Thirteen (13,426 robotic, 168,335 laparoscopic patients) studies assessed HHR outcomes, while nine (2,384 robotic, 12,225 laparoscopic patients) assessed HM outcomes. Robotic HHR had a non-significantly shorter length of hospital stay (LOS) [MD -0.41 (95% CI -0.87, -0.05)], fewer conversions to open [OR 0.22 (95% CI 0.03, 1.49)], and lower morbidity rates [OR 0.76 (95% CI 0.47, 1.23)]. Robotic HM led to significantly fewer esophageal perforations [OR 0.36 (95% CI 0.15, 0.83)], reinterventions [OR 0.18 (95% CI 0.07, 0.47)] a non-significantly shorter LOS [MD -0.31 (95% CI -0.62, 0.00)]. Both robotic HM and HHR had significantly longer operative times.

Conclusions: Laparoscopic and robotic HHR and HM repairs have similar safety profiles and perioperative outcomes. Randomized controlled trials are warranted to compare the two methods, given the low to moderate quality of included studies.