Robot-assisted versus conventional laparoscopic fundoplication: short-term outcome of a pilot randomized controlled trial
Robotic technology represents the latest development in minimally-invasive surgery. Nevertheless, robotic-assisted surgery seems to have specific disadvantages such as an increase in costs and prolongation of operative time. A general clinical implementation of the technique would only be justified if a relevant improvement in outcome could be demonstrated. This is also true for laparoscopic fundoplication. The present study was designed to compare robotic-assisted (RALF) and conventional laparoscopic fundoplication (CLF) with the focus on operative time, costs und perioperative outcome.
Forty patients with gastro-esophageal reflux disease were randomized to either RALF by use of the daVinci® Surgical System or CLF. Nissen fundoplication was the standard anti-reflux procedure. Peri-operative data such as length of operative procedure, intra-and postoperative complications, length of hospital stay, overall costs and symptomatic short-term outcome were compared.
The total operative time was shorter for RALF compared to CLF (88 vs. 102 min; p = 0.033) consisting of a longer set-up (23 vs. 20 min; p = 0.050) but a shorter effective operative time (65 vs. 82 min; p = 0.006). Intraoperative complications included one pneumothorax and two technical problems in the RALF group and two bleedings in the CLF group. There were no conversions to an open approach. Mean length of hospital stay (2.8 vs. 3.3 days; p = 0.086) and symptomatic outcome thirty days postoperatively (10% vs. 15% with ongoing PPI therapy; p = 1.0 and 25% vs. 20% with persisting mild dysphagia; p = 1.0) was similar in both groups. Costs were higher for RALF than for CLF (€ 3244 vs. € 2743, p = 0.003).
In comparison with CLF, operative time can be shorter for RALF if performed by an experienced team. However, costs are higher and short-term outcome is similar. Thus, RALF can not be favoured over CLF regarding perioperative outcome.
KeywordsRobotic surgery Laparoscopic fundoplication Gastroesophageal reflux disease Laparoscopy Randomized controlled trial
- 1.Beninca G, Garrone C, Rebecchi F, Giaccone C, Morino M (2003) Robot-assisted laparoscopic surgery. Preliminary results at our Center. Chir Ital 3: 321–331Google Scholar
- 3.Cadiere GB, Himpens J, Germay O, Izizaw R, Degueldre M, Vandromme J, Capelluto E, Bruyns J (2001) Feasibility of robotic laparoscopic surgery: 146 cases. World J Surg 11: 1467–1477Google Scholar
- 7.Dallemagne B, Weerts JM, Jehaes C, Markiewicz S, Lombard R (1991) Laparoscopic Nissen fundoplication: preliminary report. Surg Laparosc Endosc 3: 138–143Google Scholar
- 18.Kulich KR, Malfertheiner P, Madisch A, Labenz J, Bayerdorffer E, Miehlke S, Carlsson J, Wiklund IK (2003) Psychometric validation of the German translation of the Gastrointestinal Symptom Rating Scale (GSRS) and Quality of Life in Reflux and Dyspepsia (QOLRAD) questionnaire in patients with reflux disease. Health Qual Life Outcomes 1: 62PubMedCrossRefGoogle Scholar
- 19.Melvin WS, Needleman BJ, Krause KR, Schneider C, Ellison EC (2002) Computer-enhanced vs. standard laparoscopic antireflux surgery. J Gastrointest Surg 1: 11–15Google Scholar
- 29.Wykypiel H, Wetscher GJ, Klaus A, Schmid T, Gadenstaetter M, Bodner J, Bodner E (2003) Robot-assisted laparoscopic partial posterior fundoplication with the DaVinci system: initial experiences and technical aspects. Langenbecks Arch Surg 11–12: 411–416Google Scholar