A Meta-analysis of da Vinci robotic-assisted versus laparoscopic Nissen fundoplication for adult gastroesophageal reflux disease

doi:10.3877/cma.j.issn.1674-6899.2018.05.002

Abstract

Abstract:

Objective

To evaluate the efficacy and safety of da Vinci robotic-assisted Nissen fundoplication (RAF) versus conventional laparoscopic Nissen fundoplication (CLF) for adult gastroesophageal reflux disease through Meta-analysis.

Methods

PubMed, EMbase, Cochrane Library, Web of science, CNKI, WanFang Data and CBM databases were systematically researched from their inception to Jun. 2018. We also hand searched the references lists of studies identified. We selected randomized controlled trials and cohort studies on the comparison of robotic versus conventional laparoscopic Nissen fundoplication (RAF vs CLF) for adult gastroesophageal reflux disease. After two researchers independently screen literature, extract available data and evaluate quality studies from the included studies, we performed meta-analysis by Stata/SE 12. Heterogeneity was assessed using the I² statistic.

Results

11 studies were included in the meta-analysis, in which 267 patients were in the RAF group and 416 patients were in the CLF group. The meta-analysis results indicated: compared to CLF, RAF was associated with longer estimated operative time(WMD=28.83, 95%CI: 12.89-44.76, P<0.05) and higher cost (P<0.05); However, there were no statistical difference between two groups in perioperative complications, intraoperative conversion rate, pneumothorax, postoperative dysphagia, reoperation and length of hospital stay (P>0.05).

Conclusions

This meta-analysis indicated that it was effective and safe for RAF in the treatment of adult gastroesophageal reflux disease. However, due to the longer operative time and higher operative cost of RAF, it was limited in clinical practice.

Key words: Gastroesophageal reflux disease, Robot, Laparoscopic, Nissen fundoplication, Meta-analysis

Yangqin Xun, Rong Liu, Liang Yao, Tiankang Guo, Meixuan Li, Huijuan Li, Juan Ling, Cuncun Lu, Peijing Yan, Kehu Yang. A Meta-analysis of da Vinci robotic-assisted versus laparoscopic Nissen fundoplication for adult gastroesophageal reflux disease[J]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2018, 11(05): 261-267.

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URL: https://zhqjwkzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-6899.2018.05.002

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Figures/Tables 6

References 26

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第一作者	发表时间	国家	组别	例数	平均年龄(岁)	体质量指数(kg/m²)	性别(例)		随访时间
第一作者	发表时间	国家	组别	例数	平均年龄(岁)	体质量指数(kg/m²)	男	女	随访时间
Cadiere^{[ 16 ]}	2001年	比利时	RAF组	10	40.0	－	7	3	－
?	?	?	CLF组	11	38.0	－	8	3	－
Melvin^{[ 17 ]}	2002年	美国	RAF组	20	42.9	－	－	－	－
?	?	?	CLF组	20	49.6	－	－	－	－
Morino^{[ 18 ]}	2005年	意大利	RAF组	25	43.0	25.5	19	6	22.3个月
?	?	?	CLF组	25	46.3	26.1	18	7	22.3个月
Draaisma^{[ 19 ]}	2006年	荷兰	RAF组	25	48.0	25.6	16	9	6.0个月
?	?	?	CLF组	25	52.0	28.7	17	8	6.0个月
Nakadi^{[ 20 ]}	2006年	比利时	RAF组	9	44.0	25.3	6	3	32.0个月
?	?	?	CLF组	11	48.0	24.8	8	3	32.0个月
Müller－Stich^{[ 21 ]}	2007年	德国	RAF组	20	49.6	29.2	10	10	12.0个月
?	?	?	CLF组	20	50.5	26.2	12	8	12.0个月
Heemskerk^{[ 22 ]}	2007年	荷兰	RAF组	11	39.0	－	7	4	－
?	?	?	CLF组	11	41.0	－	7	4	－
Ceccarelli^{[ 23 ]}	2009年	意大利	RAF组	45	55.0	28.0	24	21	3.6年
?	?	?	CLF组	137	54.0	27.1	61	76	7.8年
Hartmann^{[ 24 ]}	2009年	德国	RAF组	18	57.0	27.2	9	9	7.0个月
?	?	?	CLF组	62	53.0	30.0	29	33	7.0个月
Tolboom^{[ 25 ]}	2016年	荷兰	RAF组	45	56.0	－	12	33	3.0个月
?	?	?	CLF组	30	57.0	－	19	11	10.0个月
Jensen^{[ 26 ]}	2017年	丹麦	RAF组	39	52.0	26.5	20	19	26.0个月
?	?	?	CLF组	64	49.4	26.9	23	41	25.0个月

第一作者	发表时间	国家	组别	例数	平均年龄(岁)	体质量指数(kg/m²)	性别(例)		随访时间
第一作者	发表时间	国家	组别	例数	平均年龄(岁)	体质量指数(kg/m²)	男	女	随访时间
Cadiere^{[ 16 ]}	2001年	比利时	RAF组	10	40.0	－	7	3	－
?	?	?	CLF组	11	38.0	－	8	3	－
Melvin^{[ 17 ]}	2002年	美国	RAF组	20	42.9	－	－	－	－
?	?	?	CLF组	20	49.6	－	－	－	－
Morino^{[ 18 ]}	2005年	意大利	RAF组	25	43.0	25.5	19	6	22.3个月
?	?	?	CLF组	25	46.3	26.1	18	7	22.3个月
Draaisma^{[ 19 ]}	2006年	荷兰	RAF组	25	48.0	25.6	16	9	6.0个月
?	?	?	CLF组	25	52.0	28.7	17	8	6.0个月
Nakadi^{[ 20 ]}	2006年	比利时	RAF组	9	44.0	25.3	6	3	32.0个月
?	?	?	CLF组	11	48.0	24.8	8	3	32.0个月
Müller－Stich^{[ 21 ]}	2007年	德国	RAF组	20	49.6	29.2	10	10	12.0个月
?	?	?	CLF组	20	50.5	26.2	12	8	12.0个月
Heemskerk^{[ 22 ]}	2007年	荷兰	RAF组	11	39.0	－	7	4	－
?	?	?	CLF组	11	41.0	－	7	4	－
Ceccarelli^{[ 23 ]}	2009年	意大利	RAF组	45	55.0	28.0	24	21	3.6年
?	?	?	CLF组	137	54.0	27.1	61	76	7.8年
Hartmann^{[ 24 ]}	2009年	德国	RAF组	18	57.0	27.2	9	9	7.0个月
?	?	?	CLF组	62	53.0	30.0	29	33	7.0个月
Tolboom^{[ 25 ]}	2016年	荷兰	RAF组	45	56.0	－	12	33	3.0个月
?	?	?	CLF组	30	57.0	－	19	11	10.0个月
Jensen^{[ 26 ]}	2017年	丹麦	RAF组	39	52.0	26.5	20	19	26.0个月
?	?	?	CLF组	64	49.4	26.9	23	41	25.0个月

第一作者	发表时间	随机序列的产生	分配隐藏	盲法	数据的不完整性	数据的选择性	基线的可比性	是否提前终止实验
Cadiere^{[ 16 ]}	2001年	不清楚	不清楚	不清楚	是	是	是	不清楚
Morino^{[ 18 ]}	2005年	随机数字表	密封的不透明信封	不清楚	是	是	是	不清楚
Draaisma^{[ 19 ]}	2006年	不清楚	不清楚	不清楚	是	是	是	不清楚
Nakadi^{[ 20 ]}	2006年	信封	密封的不透明信封	否	是	是	是	不清楚
Müller-Stich^{[ 21 ]}	2007年	不清楚	不清楚	单盲	是	是	是	不清楚

第一作者	发表时间	随机序列的产生	分配隐藏	盲法	数据的不完整性	数据的选择性	基线的可比性	是否提前终止实验
Cadiere^{[ 16 ]}	2001年	不清楚	不清楚	不清楚	是	是	是	不清楚
Morino^{[ 18 ]}	2005年	随机数字表	密封的不透明信封	不清楚	是	是	是	不清楚
Draaisma^{[ 19 ]}	2006年	不清楚	不清楚	不清楚	是	是	是	不清楚
Nakadi^{[ 20 ]}	2006年	信封	密封的不透明信封	否	是	是	是	不清楚
Müller-Stich^{[ 21 ]}	2007年	不清楚	不清楚	单盲	是	是	是	不清楚

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