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Updated: May 1, 2026
Robotic Myotomy and Partial Fundoplication for Achalasia
Published on: August 11, 2023
Meta analysis of robot-assisted versus conventional laparoscopic fundoplication in children
Thomas P Cundy1, Leanne Harling2, Hani J Marcus1
1The Hamlyn Centre, Institute of Global Health Innovation, Imperial College, London, UK; Department of Surgery and Cancer, St Mary's Hospital, Imperial College, London, UK.
Insights
Robot-assisted fundoplication (RF) and laparoscopic fundoplication (LF) appear comparable in safety and short-term efficacy for children. More research is needed to fully understand long-term effectiveness and specific outcomes for these minimally invasive procedures.
Area of Science:
- Pediatric surgery
- Minimally invasive surgical techniques
- Comparative effectiveness research
Background:
- Minimally invasive fundoplication in children can be performed using robot-assisted (RF) or laparoscopic (LF) methods.
- Current evidence comparing RF and LF in pediatric populations is limited and requires clarification.
Purpose of the Study:
- To systematically review and meta-analyze existing literature comparing the safety and efficacy of RF versus LF in pediatric patients.
- To elucidate comparative outcomes for minimally invasive fundoplication techniques in children.
Main Methods:
- A systematic review and meta-analysis of comparative studies on RF versus LF in children.
- Inclusion of six observational studies with 297 pediatric patients; no randomized controlled trials were found.
- Analysis focused on safety (morbidity, conversions) and efficacy (success, re-operation, complications, LOS, OT, analgesia, cost).
Main Results:
- No significant differences were found between RF and LF regarding intra-operative conversions, operating time, length of hospital stay, or early post-operative complications.
- Limited evidence suggests that robot-assisted fundoplication may be associated with higher costs.
- Data for other efficacy outcomes were insufficient due to a lack of standardized, long-term follow-up.
Conclusions:
- Robot-assisted fundoplication and laparoscopic fundoplication demonstrate comparable safety and short-term efficacy in pediatric patients.
- Insufficient evidence exists to definitively compare effectiveness for crucial procedure-specific outcomes.
- Further high-quality studies with extended follow-up are necessary to provide a comprehensive comparison.
Background:
Minimally invasive fundoplication may be performed using either a robot-assisted (RF) or conventional laparoscopic (LF) technique. Evidence comparing RF and LF in children remains unclear. This study aims to elucidate the comparative safety and efficacy of RF versus LF by systematic review and meta-analysis.
Methods:
Comparative studies investigating RF versus LF in children were identified from multiple electronic literature databases. Meta-analysis was performed using random effects modeling. Safety parameters investigated were post-operative morbidity and intra-operative conversions. Efficacy outcomes of interest were operative success, re-operation, post-operative complications, length of hospital stay (LOS), total operating time (OT), analgesia requirement, and cost.
Results:
Six observational studies met inclusion criteria, reporting outcomes of 297 children. No randomized controlled trials were identified. Pooled analysis determined no statistically significant differences between RF and LF for conversions, OT, LOS, and post-operative complications. There was no standardized follow up beyond the early post-operative period to enable data synthesis for remaining outcomes of interest. Limited evidence indicates higher costs with RF.
Conclusions:
Safety and short-term efficacy seem comparable between RF and LF in children. There is insufficient evidence to assess comparative effectiveness for many important procedure specific outcome measures. Higher quality and longer follow-up studies are required.
