Comparative analysis of robotic and laparoscopic techniques in hiatal hernia and crural repair: a review of current evidence and outcomes.

IF 2.6 2区医学 Q1 SURGERY Hernia Pub Date : 2024-10-01 Epub Date: 2024-08-10 DOI:10.1007/s10029-024-03126-5

I Karikis, N Pachos, E Mela, K Saliaris, E Kitsou, D Linardoutsos, S Triantafyllou, D Theodorou

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Abstract

Purpose: The purpose of this narrative review is to evaluate the implementation of robotic surgery in hiatal hernia and crural repair, based on the existing literature and to compare this approach to other established techniques.

Methods: We performed a non- systematic literature search of PubMed and MEDLINE on February 25, 2024 for papers published to date focusing on the surgical repair of hiatal hernias using the robotic platform. After eliminating publications based on eligibility criteria, 13 studies were selected for analysis.

Results: Robotic surgery is increasingly utilized in hiatal hernia repair due to its enhanced ergonomics and superior visualization capabilities. Operative times vary, with some studies indicating longer durations for robotic surgery (e.g., Giovannetti et al. demonstrated median operative time of 196 min for robotic compared to 145 min for laparoscopic) while others report shorter times (e.g., Lang F et al. demonstrated 88 min for robotic versus 102 min for laparoscopic). Recurrence rates between robotic and laparoscopic repairs are comparable, with reported recurrence rates of 1.8% for robotic and 1.2% for laparoscopic approaches by Benedix et al. Robotic surgery offers potential advantages, including reduced intraoperative blood loss (e.g., Giovannetti et al. mentioned median blood loss of 20 ml for robotic versus 50 ml for laparoscopic). The length of hospital stay and postoperative complication rates also vary, with some studies suggesting shorter stays and fewer complications for robotic surgery as surgeons become more proficient. Soliman et al. reported a statistically significant reduction in complication rates with robotic surgery (6.3% versus 19.2%).

Conclusions: Robotic surgery presents promising results regarding the length of hospital stay, conversion rate to open surgery and postoperative complication rates when compared to laparoscopy based on the existing literature. Despite the lack of striking differences, robotic hiatal hernia repair is a valid and evolving approach.

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食管裂孔疝和嵴修补术中机器人和腹腔镜技术的比较分析：当前证据和结果综述。

目的：这篇叙述性综述的目的是根据现有文献评估机器人手术在食管裂孔疝和嵴修补术中的应用情况，并将这种方法与其他成熟技术进行比较：我们于 2024 年 2 月 25 日在 PubMed 和 MEDLINE 上进行了非系统性文献检索，检索迄今为止发表的使用机器人平台进行食管裂孔疝手术修复的论文。根据资格标准剔除文献后，选出 13 项研究进行分析：结果：由于机器人手术符合人体工程学并具有卓越的可视化能力，因此越来越多地应用于食管裂孔疝修补术中。手术时间各不相同，一些研究表明机器人手术时间更长（例如，Giovannetti 等人的研究表明机器人手术的中位手术时间为 196 分钟，而腹腔镜手术为 145 分钟），而另一些研究报告的手术时间更短（例如，Lang F 等人的研究表明机器人手术为 88 分钟，而腹腔镜手术为 102 分钟）。机器人手术和腹腔镜修复术的复发率相当，据 Benedix 等人报道，机器人手术的复发率为 1.8%，腹腔镜手术为 1.2%。机器人手术具有潜在的优势，包括减少术中失血（例如，Giovannetti 等人提到机器人手术的中位失血量为 20 毫升，而腹腔镜手术为 50 毫升）。住院时间和术后并发症发生率也不尽相同，一些研究表明，随着外科医生技术越来越熟练，机器人手术的住院时间更短，并发症更少。Soliman等人报告称，机器人手术的并发症发生率在统计学上有显著降低（6.3%对19.2%）：根据现有文献，与腹腔镜手术相比，机器人手术在住院时间、转为开腹手术率和术后并发症发生率方面都有良好的效果。尽管缺乏显著差异，但机器人食管裂孔疝修补术是一种有效且不断发展的方法。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Hernia SURGERY-

CiteScore

4.90

自引率

26.10%

发文量

171

审稿时长

4-8 weeks

期刊介绍： Hernia was founded in 1997 by Jean P. Chevrel with the purpose of promoting clinical studies and basic research as they apply to groin hernias and the abdominal wall . Since that time, a true revolution in the field of hernia studies has transformed the field from a ”simple” disease to one that is very specialized. While the majority of surgeries for primary inguinal and abdominal wall hernia are performed in hospitals worldwide, complex situations such as multi recurrences, complications, abdominal wall reconstructions and others are being studied and treated in specialist centers. As a result, major institutions and societies are creating specific parameters and criteria to better address the complexities of hernia surgery. Hernia is a journal written by surgeons who have made abdominal wall surgery their specific field of interest, but we will consider publishing content from any surgeon who wishes to improve the science of this field. The Journal aims to ensure that hernia surgery is safer and easier for surgeons as well as patients, and provides a forum to all surgeons in the exchange of new ideas, results, and important research that is the basis of professional activity.