An analysis of short-term outcomes of robotic-assisted versus conventional laparoscopic esophageal hiatal hernia repair combined with nissen fundoplication

doi:10.3877/cma.j.issn.1674-392X.2024.05.007

Abstract

Abstract:

Objective

To compare the clinical efficacy of robotic-assisted and conventional laparoscopic esophageal hiatal hernia repair combined with Nissen fundoplication, and to explore the safety and feasibility of applying a robotic-assisted system.

Methods

We retrospectively analyzed the clinical data of 155 patients who underwent esophageal hiatal hernia repair combined with Nissen fundoplication in the Minimally Invasive, Hernia and Abdominal Wall Surgery Department of the Xinjiang Uygur Autonomous Region People's Hospital from April 2022 to April 2023, and divided them into robotic and laparoscopic groups according to the surgical protocols, of which 59 cases were in the robotic group and 96 cases were in the laparoscopic group. We compared the perioperative clinical indicators, postoperative hospitalization time, and improvement of symptoms before and after surgery.

Results

All patients successfully completed the surgery, without intermediate open or change of operation, and no serious complications related to surgery occurred. The differences between the two groups in age, gender, body mass index, preoperative proton pump inhibitor taking time, preoperative high-resolution esophageal manometry, and preoperative test indexes were not statistically significant (P＞0.05); the surgical operation time of the robotic group and the laparoscopic group were comparable [2 (1.00) h than 2(0.98) h], the difference was not statistically significant (Z=-0.62, P=0.532). The robotic group had less intraoperative bleeding [(25.32±2.59) ml than (39.74±4.92) ml, t=23.84, P＜0.001] and shorter postoperative hospitalization [4 (2.75) d than 5 (3.00) d, Z=-3.18, P=0.001] than the laparoscopic group, and the differences were statistically significant. 2 groups did not have any readmission cases within 30 d, the difference was not statistically significant (Z=-1.36, P=0.172).

Conclusion

Compared with laparoscopic esophageal hiatal hernia repair combined with Nissen fundoplication, robot-assisted repair has less intraoperative bleeding, less trauma, shorter hospitalization time, and good near-term results.

Key words: Hernia, hiatal, Artificial intelligence, Robot assisted surgery, Fundoplication, Clinical efficacy

Yiliang Li, Yakufu Sulayiman, Maimaitiming Maimaitiaili, Abudoureyimu Kelimu. An analysis of short-term outcomes of robotic-assisted versus conventional laparoscopic esophageal hiatal hernia repair combined with nissen fundoplication[J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2024, 18(05): 512-517.

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Figures/Tables 5

组别	例数	年龄(岁, $\overset{ˉ}{x}$ ±s)	性别[例(%)]		质子泵抑制剂服用史[例(%)]	高血压[例(%)]	糖尿病[例(%)]
组别	例数	年龄(岁, $\overset{ˉ}{x}$ ±s)	男性	女性	质子泵抑制剂服用史[例(%)]	高血压[例(%)]	糖尿病[例(%)]
机器人组	59	58.22±11.22	26(44.1)	33(55.9)	53(89.8)	19(32.2)	8(13.6)
腹腔镜组	96	56.67±9.32	41(42.7)	55(57.3)	89(92.7)	22(22.9)	9(9.4)
t/χ²		0.932^①	0.028		0.394	1.620	0.655
P值		0.353	0.868		0.530	0.203	0.418

组别	例数	年龄(岁, $\overset{ˉ}{x}$ ±s)	性别[例(%)]		质子泵抑制剂服用史[例(%)]	高血压[例(%)]	糖尿病[例(%)]
组别	例数	年龄(岁, $\overset{ˉ}{x}$ ±s)	男性	女性	质子泵抑制剂服用史[例(%)]	高血压[例(%)]	糖尿病[例(%)]
机器人组	59	58.22±11.22	26(44.1)	33(55.9)	53(89.8)	19(32.2)	8(13.6)
腹腔镜组	96	56.67±9.32	41(42.7)	55(57.3)	89(92.7)	22(22.9)	9(9.4)
t/χ²		0.932^①	0.028		0.394	1.620	0.655
P值		0.353	0.868		0.530	0.203	0.418

组别	例数	酸反流次数( $\overset{ˉ}{x}$ ±s)	弱酸反流次数[M(IQR)]	食管下括约肌平均静息压( $\overset{ˉ}{x}$ ±s)	术前白细胞[10⁹/L,M(IQR)]	血红蛋白[g/L,M(IQR)]	红细胞[10¹²/L,M(IQR)]	胆固醇(mmol/L, $\overset{ˉ}{x}$ ±s)
机器人组	59	25.42±25.97	17(33)	12.00±9.90	6.42(2.08)	135(26.00)	4.6(0.72)	3.92±1.10
腹腔镜组	96	25.35±23.91	21(34)	12.57±10.55	5.89(2.47)	136(23.75)	4.6(0.82)	4.24±1.07
t/Z值		-0.017^①	1.268	0.336^①	1.196	0.732	0.308	1.792^①
P值		0.986	0.205	0.737	0.232	0.464	0.758	0.075

组别	例数	酸反流次数( $\overset{ˉ}{x}$ ±s)	弱酸反流次数[M(IQR)]	食管下括约肌平均静息压( $\overset{ˉ}{x}$ ±s)	术前白细胞[10⁹/L,M(IQR)]	血红蛋白[g/L,M(IQR)]	红细胞[10¹²/L,M(IQR)]	胆固醇(mmol/L, $\overset{ˉ}{x}$ ±s)
机器人组	59	25.42±25.97	17(33)	12.00±9.90	6.42(2.08)	135(26.00)	4.6(0.72)	3.92±1.10
腹腔镜组	96	25.35±23.91	21(34)	12.57±10.55	5.89(2.47)	136(23.75)	4.6(0.82)	4.24±1.07
t/Z值		-0.017^①	1.268	0.336^①	1.196	0.732	0.308	1.792^①
P值		0.986	0.205	0.737	0.232	0.464	0.758	0.075

组别	例数	手术时间[h,M(IQR)]	术中出血量(ml, $\overset{ˉ}{x}$ ±s)	术后住院时间[d,M(IQR)]	30d内再入院率[例(%)]
机器人组	59	2(1.00)	25.32±2.59	4(2.75)	0(0)
腹腔镜组	96	2(0.98)	39.74±4.92	5(3.00)	0(0)
t/Z值		-0.62	23.84^①	-3.18	-1.36
P值		0.532	＜0.001	0.001	0.172

组别	例数	手术时间[h,M(IQR)]	术中出血量(ml, $\overset{ˉ}{x}$ ±s)	术后住院时间[d,M(IQR)]	30d内再入院率[例(%)]
机器人组	59	2(1.00)	25.32±2.59	4(2.75)	0(0)
腹腔镜组	96	2(0.98)	39.74±4.92	5(3.00)	0(0)
t/Z值		-0.62	23.84^①	-3.18	-1.36
P值		0.532	＜0.001	0.001	0.172

组别	例数	体重指数(kg/m², $\overset{ˉ}{x}$ ±s)		t值	P值	HRQL评分( $\overset{ˉ}{x}$ ±s)		t值	P值	Gerd Q评分( $\overset{ˉ}{x}$ ±s)		t值	P值
组别	例数	术前	术后1年	t值	P值	术前	术后1年	t值	P值	术前	术后1年	t值	P值
机器人组	59	26.85±5.33	24.49±4.02	6.15	＜0.001	38.00±7.65	9.91±3.08	27.19	＜0.001	10.88±1.96	6.88±1.21	13.46	＜0.001
腹腔镜组	96	26.20±3.77	24.77±3.36	8.21	＜0.001	39.36±6.28	9.95±3.31	44.51	＜0.001	10.94±1.68	7.34±0.93	16.84	＜0.001
t值		0.818	-0.466			1.207	-2.669			0.189	-0.061
P值		0.415	0.642			0.229	0.008			0.850	0.951

组别	例数	体重指数(kg/m², $\overset{ˉ}{x}$ ±s)		t值	P值	HRQL评分( $\overset{ˉ}{x}$ ±s)		t值	P值	Gerd Q评分( $\overset{ˉ}{x}$ ±s)		t值	P值
组别	例数	术前	术后1年	t值	P值	术前	术后1年	t值	P值	术前	术后1年	t值	P值
机器人组	59	26.85±5.33	24.49±4.02	6.15	＜0.001	38.00±7.65	9.91±3.08	27.19	＜0.001	10.88±1.96	6.88±1.21	13.46	＜0.001
腹腔镜组	96	26.20±3.77	24.77±3.36	8.21	＜0.001	39.36±6.28	9.95±3.31	44.51	＜0.001	10.94±1.68	7.34±0.93	16.84	＜0.001
t值		0.818	-0.466			1.207	-2.669			0.189	-0.061
P值		0.415	0.642			0.229	0.008			0.850	0.951

References 25

[1]	Yu HX, Han CS, Xue JR, et al. Esophageal hiatal hernia: risk,diagnosis and management[J]. Expert Rev Gastroenterol Hepatol,2018, 12(4): 319-329.
[2]	Tjeerdsma M, Quinn KR, Helmer SD, et al. Comparing Outcomes of Robotic-Assisted versus Conventional Laparoscopic Hiatal Hernia Repair[J]. Kans J Med, 2022, 15: 365-368.
[3]	Savni S, Sarang K, Avian C, et al. Functional outcomes of hybrid hiatal hernia repair[J]. J Robot Surg, 2022, 17(1): 197-203.
[4]	Tolboom RC, Draaisma WA, Broeders IA. Evaluation of conventional laparoscopic versus robot-assisted laparoscopic redo hiatal hernia and antireflux surgery: a cohort study[J]. J Robot Surg,2016, 10(1): 33-39.
[5]	刘成, 赖聪, 黄健, 等. EDGE SP1000单孔手术机器人辅助腹腔镜下猪输尿管部分切除联合端端吻合术的可行性研究[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(6): 642-646.
[6]	李赞林, 赛米·赛麦提, 李义亮, 等. 腹腔镜胃袖状切除联合食管裂孔疝修补术治疗肥胖合并胃食管反流病疗效Meta 分析[J].中国实用外科杂志, 2020, 40(10): 1185-1189.
[7]	麦麦提艾力·麦麦提明, 艾克拜尔, 李义亮, 等. 生物补片在腹腔镜下食管裂孔疝修补术的临床疗效分析[J/OL]. 中华胃食管反流病电子杂志, 2019, 6(3): 144-147.
[8]	Ward AM, Hasan SS, Sanchez EC, et al. Complications Following Robotic Hiatal Hernia Repair Are Higher Compared to Laparoscopy[J]. J Gastrointest Surg, 2021, 25(12): 3049-3055.
[9]	刘容, 翁铭芳, 郭春雨, 等. 机器人辅助与普通腹腔镜前列腺癌根治术对老年患者尿控功能的影响[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(02): 169-172.
[10]	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?[J]. Langenbecks Arch Surg, 2021, 406(5):1387-1395.
[11]	Mi J, Kang Y, Chen X, et al. Whether robot-assisted laparoscopic fundoplication is better for gastroesophageal reflux disease in adults:a systematic review and meta-analysis[J]. Surg Endosc, 2010, 24(8):1803-1814.
[12]	麦麦提艾力·麦麦提明, 多力坤·牙生, 伊尔夏提江·艾尼瓦尔,等. 机器人和腹腔镜食管裂孔疝修补术短期临床疗效回顾性队列研究[J]. 中华外科杂志, 2023, 61(6): 498-502.
[13]	Pugin F, Bucher P, Morel P. History of robotic surgery : From AESOP^® and ZEUS^® to da Vinci^®[J/OL]. J Visc Surg, 2011, 148(5):e3-e8.
[14]	Pötscher A, Bittermann C, Längle F. Robot-assisted esophageal surgery using the da Vinci® Xi system: operative technique and initial experiences[J]. J Robot Surg, 2019, 13(3): 469-474.
[15]	Silas N, Abdul R, Alex K, et al. Robot-assisted general surgery is safe during the learning curve: a 5-year Australian experience[J]. J Robot Surg, 2023, 17(4): 1541-1546.
[16]	Vasnev OS, Izrailov RE, Domrachev SA. Robotic redo fundoplication after antireflux surgery: a narrative review[J]. Dokazatel Naya Gastroenterologiya, 2022, 11(2): 44.
[17]	Ma L, Luo H, Kou S, et al. Robotic versus laparoscopic surgery for hiatal hernia repair: a systematic literature review and meta-analysis[J]. J Robot Surg, 2023, 17(5): 1879-1890.
[18]	李镇顺, 钱锋, 石彦, 等. 完全机器人手术系统和机器人手术系统辅助胃癌根治术的近期疗效分析[J]. 中华消化外科杂志, 2023,22(4): 512-518.
[19]	Soliman BG, Nguyen DT, Chan EY, et al. Robot-assisted hiatal hernia repair demonstrates favorable short-term outcomes compared to laparoscopic hiatal hernia repair[J]. Surg Endosc, 2020, 34(6):2495-2502.
[20]	Kamolz T, Bammer T, Pointner R. Predictability of dysphagia after laparoscopic Nissen fundoplication[J]. Am J Gastroenterol, 2000,95(2): 408-414.
[21]	吾布力卡斯木·吾拉木, 艾克拜尔·艾力, 李义亮, 等. 抗反流手术对体重的影响[J/OL]. 中华胃食管反流病电子杂志, 2019,6(4): 192-195.
[22]	Ahmed T, Mohammed I. Laparoscopic Nissen Fundoplication Plus Mid-gastric Plication for Treatment of Obese Patients with Gastroesophageal Reflux Disease[J]. Obes Surg, 2018, 28(2):437-443.
[23]	Hahnloser D, Schumacher M, Cavin R, et al. Risk factors for complications of laparoscopic Nissen fundoplication[J]. Surg Endosc, 2002, 16(1): 43-47.
[24]	Kamolz T, Granderath FA, Bammer T, et al. "Floppy" Nissen vs.Toupet laparoscopic fundoplication: quality of life assessment in a 5-year follow-up(part 2)[J]. Endoscopy, 2002, 34(11): 917-922.
[25]	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[J]. Surg Endosc, 2021, 36(1): 1-9.

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