ThTP2.14 Robot-assisted repair of paraoesophageal hernia: a systematic review

Abstract Aim Laparoscopic repair is quoted as the standard of care for paraoesophageal herniae but limitations include the 2D image, requirement of a trained camera assistant and surgeon fatigue. Robotic-assisted (RA) repair promises improved 3D visualization and ergonomics. However, there is limited data on short and long-term outcomes from RA repair. We aimed to systematically review literature on RA repair of paraoesophageal herniae and post-operative outcomes. Methods A systematic on-line literature search of Embase and Medline identified 200 articles of which 13 relevant studies were selected, including 7 retrospective and 6 prospective studies. Selected articles were assessed by two reviewers to extract relevant demographic and outcome data. Results 1601 patients received RA repair of paraoesophageal herniae with a median age of 62 years and 72% were female. The majority had Hill type 3 paraoesophageal herniae (80.5%). Predominately elective operations (86.4%) they had a mean operative time of 169.7 minutes, used mesh in 44.0% and included a fundoplication in 78.2%. Only one required open conversion. Median length of stay was 2.45 days (1.3-4.5 days). 15.4% had reported complications (dysphagia (9.7%), pneumothorax (0.4%), pneumonia (0.3%) post-operative haemorrhage (0.3%) and thrombosis (0.4%)). There were no post-operative mortalities. Few symptomatic recurrences were reported and there was a 1.8% re-operation rate within this cohort. Conclusion RA paraoesophageal hernia repair offers similar outcomes to those published in recent literature for laparoscopic repair, with potential for improved surgeon ergonomics and visualisation. Carefully designed, prospective trials comparing laparoscopic and robotic repair are required to further delineate the optimal surgical approach.