Robot-assisted vs. laparoscopic Nissen fundoplication in children: an updated meta-analysis with systematic literature review

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Abstract
This updated meta-analysis with systematic review aimed to enhance the understanding of robotics in surgical GERD treatment by comparing the reliability and efficacy of two surgical approaches for Nissen fundoplication in pediatric patients: conventional laparoscopy (LNF- laproscopic Nissen fundoplication) and robot-assisted laparoscopy (RNF- robotic Nissen fundoplication). RF has gained increasing popularity among pediatric surgeons in recent years. Major electronic databases were searched for studies comparing LNF and RNF, including publications from their inception through October 2024. Safety outcomes assessed included intra- and post-operative complications and conversions to laparotomy. Efficacy measures included length of hospital stay (LOS), total operative time (OT), analgesia requirements, gastrostomy needs, and cost-per-procedure. This meta-analysis was conducted using a random-effects model. Initially 601 articles were identified, however only 10 met our inclusion criteria and were included in this study, comprising a study group of 499 children. The pooled analysis found no significant differences in patient characteristics between the LNF and RNF groups. Furthermore, no statistically significant differences were identified between the two techniques regarding conversions to open surgery, OT, LOS, or postoperative complications. We conclude, that the findings of this meta-analysis indicate that RNF and LNF are comparable in terms of safety and efficacy parameters. However, until certain clinical benefits are proven, the use of RF instead of LF can be justified by other advantages, such as better ergonomics, elimination of tremors, and a greater range of wrist motion, to offset the additional costs associated with its initial acquisition and monthly maintenance.

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