Department of Surgery, The Second Hospital of Lanzhou University, Lanzhou 730030, China.
Surg Endosc. 2010 Aug;24(8):1803-14. doi: 10.1007/s00464-009-0873-9. Epub 2010 Jan 29.
BACKGROUND: Although laparoscopic fundoplication is an effective, minimally invasive surgical technique for gastroesophageal reflux disease (GERD) that failed to be treated with medicine, with wide implementation its technical limitations have become increasingly clear. Recently, robot-assisted laparoscopic fundoplication (RALF) was considered a new approach that makes up for the deficiency of conventional laparoscopic fundoplication (CLF). This systematic review aimed to assess the feasibility and efficiency of robot-assisted laparoscopic fundoplication for GERD. METHODS: Two reviewers independently searched and identified seven randomized controlled trials (RCTs) and four clinical controlled trials (CCTs) of RALF versus CLF for GERD in the Cochrane database, Medline, Embase, and Science citation index between 2001 and 2009. The main outcomes were operating time, complication rate, hospital stay, and costs. The meta-analysis was performed by Review Manager 5.0 software. The effect size of the clinical outcomes was evaluated by odds ratio (OR), weighted mean difference (WMD), and standard mean difference (SMD) according to different data type. Heterogeneity and sensitivity analysis were used to account for rationality of pooling data and sources of heterogeneity. RESULTS: Of 483 studies found, a total of 11 trials were included in this review; among 533 patients, 198 patients underwent RALF and 335 patients underwent CLF. The results of meta-analysis showed that the postoperative complication rate (OR = 0.35, 95% CI = [0.13, 0.93], p = 0.04) is lower for RALF, but the total operating time (WMD = 24.05, 95% CI = [5.19, 42.92], p = 0.01) is longer for RALF compared with those for CLF. Statistically, there was no significant difference between the two groups with regard to perioperative complication rate (OR = 0.67, 95% CI = [0.30, 1.48], p = 1.00) and length of hospital stay (WMD = 0.00, 95% CI = [-0.25, 0.26], p = 0.04). CONCLUSIONS: Systematic review of the literature indicates that RALF is a feasible and safe alternative to surgical treatment of GERD. However, since it lacks obvious advantages with respect to operating time, length of hospital stay and cost, RALF has limitations for its extensive application in clinics.
背景：腹腔镜胃底折叠术是一种治疗胃食管反流病（GERD）的有效微创手术，对于药物治疗无效的 GERD 患者，该手术效果显著。但随着腹腔镜胃底折叠术的广泛应用，其技术局限性也逐渐显现。近年来，机器人辅助腹腔镜胃底折叠术（RALF）被认为是一种弥补传统腹腔镜胃底折叠术（CLF）缺陷的新技术。本系统评价旨在评估机器人辅助腹腔镜胃底折叠术治疗 GERD 的可行性和有效性。
方法：两位评审员分别在 Cochrane 数据库、Medline、Embase 和 Science Citation Index 中检索了 2001 年至 2009 年间发表的关于 RALF 与 CLF 治疗 GERD 的 7 项随机对照试验（RCT）和 4 项临床对照试验（CCT）。主要结局指标为手术时间、并发症发生率、住院时间和费用。使用 Review Manager 5.0 软件进行荟萃分析。根据不同的数据类型，采用比值比（OR）、加权均数差（WMD）和标准均数差（SMD）评估临床结局的效应大小。使用异质性和敏感性分析来解释合并数据的合理性和异质性的来源。
结果：在检索到的 483 项研究中，共有 11 项试验被纳入本综述，共有 533 名患者，其中 198 名患者接受 RALF，335 名患者接受 CLF。荟萃分析结果显示，RALF 的术后并发症发生率（OR = 0.35，95%CI = [0.13, 0.93]，p = 0.04）较低，但 RALF 的总手术时间（WMD = 24.05，95%CI = [5.19, 42.92]，p = 0.01）较长。两组患者在围手术期并发症发生率（OR = 0.67，95%CI = [0.30, 1.48]，p = 1.00）和住院时间（WMD = 0.00，95%CI = [-0.25, 0.26]，p = 0.04）方面差异无统计学意义。
结论：系统评价结果表明，RALF 是一种治疗 GERD 的可行且安全的手术方法。但由于在手术时间、住院时间和费用方面缺乏明显优势，RALF 在临床上的广泛应用受到限制。
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