O53: Robotic Benign Upper GI Surgery: A Systematic Review Free

Robotic surgery has gained popularity in General Surgical units for resectional procedures, however its use in 'benign' operations is limited in the UK. We aim to review the current literature for common benign UGI operations.

Using PRISMA guidelines, we completed a literature search of MEDLINE and EMBASE including all evidence for Robotic Cholecystectomy (RC), Robotic Heller Cardiomyotomy (RH), Robotic Fundoplication (RF), Robotic Hiatus Hernia Repair (RHHR). Data was extracted and synthesised by independent reviewers.103 studies were included. 55 for RC, 12 for RH, 20 for RF and 14 for RHHR. The majority of these studies were cohort and case-control studies (53%). There were only 9 RCTs.

Due to significant heterogeneity in patient population, study design and outcome reporting, meta analyses were not appropriate. Trends observed for RC suggested that the robotic method can lead to improved post-operative pain and cosmesis, especially in single-incision robotic cholecystectomy (SIRC). However 2 cohort studies stated a small increased risk of CBD injury. Evidence for RH show shorter operative time and reduced risk of oesophageal perforation, with other outcomes equivalent. Studies for RF showed equivalence between laparoscopic and robotic methods. In more complex hiatus hernia repair or re-operative operations (RHHR), studies showed shorter operative time, reduced complication rate and equivalent recurrence.

This systematic review has highlighted the paucity of high quality evidence for robotic Upper GI procedures. Studies show at least equivalence between robotic and laparoscopy for less complex procedures, with strong trends towards superiority for more complex procedures such as RH and RHHR.