Improved outcomes with robotic-assisted laparoscopic paraesophageal hernia repairs compared with laparoscopic and transthoracic approaches: A single high-volume institution experience

IF 1.9

JTCVS open Pub Date : 2025-08-01 DOI:10.1016/j.xjon.2025.06.016

Katelyn R. Ward MD , Jenny Bui MD, MPH , Irina Bondarenko MS , Andrew Chang MD , Kiran Lagisetty MD , Jules Lin MD , Chigozirim N. Ekeke MD , David D. Odell MD, MMSc , Rishindra M. Reddy MD, MBA

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引用次数: 0

Abstract

Objectives

Laparoscopic (lap) paraesophageal hernia repair has excellent short-term outcomes but higher long-term recurrence rates compared with the transthoracic repair. We hypothesized that the robotic-assisted lap (robot) approach would have similarly good short-term outcomes as lap, but also lower recurrence rates.

Methods

A retrospective study of prospectively collected data was performed for paraesophageal hernia repairs at a single high-volume quaternary hospital from July 2018 to September 2022. Outcomes analyzed included 2-year postoperative radiographic recurrence (Rad), Society of Thoracic Surgeons-defined radiographic recurrence (STS-rad), symptomatic recurrence (Sx), and perioperative outcomes. Lap, robot, and transthoracic groups were compared using univariate, multivariate, and propensity score analysis.

Results

Among 207 cases (52 lap, 90 robot, and 65 transthoracic), robot was lower than lap (odds ratio [OR], 0.13-0.17; P < .01) and similar to transthoracic (OR, 0.79-1.02; P > .05) in univariate and multivariate analyses. STS-rad was similar between approaches across analyses, apart from robot being higher than transthoracic on propensity score analysis (OR, 1.83; P < .01). Robotic Sx recurrence was lower in robot compared with lap across analyses (OR, 0.40-0.50; P < .001). Median length of stay was 2 days for robot and lap, significantly shorter than transthoracic (median, 5 days; P < .01). Fewer postoperative complications occurred in robot compared with transthoracic (OR, 0.19-0.21; P < .01). Reoperation and endoscopic intervention were lower in robot compared with lap (OR, 0.09-0.12; P < .01 and OR, 0.32-0.40; P < .05).

Conclusions

Robotic paraesophageal hernia repairs had generally lower 2-year recurrence and reoperation than lap and shorter hospital stays and fewer immediate complications than transthoracic.

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与腹腔镜和经胸入路相比，机器人辅助腹腔镜食管旁疝修复的改善效果：一项单一的高容量机构经验

目的腹腔镜（膝上）食管旁疝修补术短期疗效好，但长期复发率较经胸修补术高。我们假设机器人辅助人工髋关节置换术（robot -assisted lap）的短期疗效与人工髋关节置换术相似，但复发率更低。方法回顾性分析2018年7月至2022年9月在一家大容量第四医院进行的食管旁疝修补手术的前瞻性数据。结果分析包括术后2年放射学复发（Rad）、胸外科学会定义的放射学复发（STS-rad）、症状性复发（Sx）和围手术期结果。通过单因素、多因素和倾向评分分析比较膝上组、机器人组和经胸组。结果在207例患者中（52例膝上手术，90例机器人手术，65例经胸手术），单因素和多因素分析中，机器人手术的优势比低于膝上手术（OR: 0.13-0.17; P < 0.01），与经胸手术相似（OR: 0.79-1.02; P > 0.05）。STS-rad在不同分析方法之间相似，除了机器人倾向评分分析高于经胸（OR, 1.83; P < .01）。与交叉分析相比，机器人的Sx复发率较低（OR, 0.40-0.50; P < .001）。机器人手术和膝上手术的中位住院时间为2天，显著短于经胸手术（中位为5天；P < 0.01）。与经胸手术相比，机器人手术的术后并发症发生率更低（OR, 0.19-0.21; P < 0.01）。与人工手术相比，机器人手术的再手术率和内镜干预率较低（OR, 0.09-0.12; P <； 01和OR， 0.32-0.40; P < 05）。结论机器人食管旁疝修补术2年复发率和再手术率均低于经胸手术，住院时间短，即刻并发症少。

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来源期刊

JTCVS open

CiteScore

1.70

自引率

0.00%

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