Robot-assisted laparoscope fundoplication for gastroesophageal reflux disease: a systematic review of randomized controlled trials.

Objective: To evaluate the efficacy and safety of robot-assisted fundoplication (RAF) for treating gastroesophageal reflux disease (GERD). Methods: Randomized controlled trials (RCTs) or quasi-RCTs were searched for in PubMed, EM-BASE, the Cochrane Library, SCI, Chinese Biomedical Database, China Academic Journals Full-Text Database, Chinese Scientific Journals Database, China online journals, and related journals. We evaluated the quality of the included studies by using the 5.0.1 Cochrane Handbook standards and analyzed the data using the Cochrane Collaboration's RevMan 5.0. Results: Five studies (n = 181) were included. A meta-analysis showed that besides the time taken to carry out fundoplication (p < 0.00001), both RAF and conventional laparoscopic fundoplication (CLF) were similar in postoperative antisecretory medication (p = 1.0), intraoperative conversion to open surgery (p = 0.94), postoperative dysphagia (p = 1.0), pneumothorax (p = 1.0), total intraoperative complications (p = 0.24), the time of hiatal dissection (p = 0.98), the time of incision to completion of sutures (p = 0.95), total operation time (p = 0.16), hospital stay (p = 0.97), and total cost (p = 0.25). Conclusions: The current evidence demonstrates that RAF is safe and effective in treating GERD. The weakness of this treatment method is that it prolongs the time necessary to carry out fundoplication. However, RAF should be the future trend for treating GERD. Copyright (C) 2009 S. Karger AG, Basel