title: Meta analysis of robot-assisted versus conventional laparoscopic fundoplication in children.
abstract: 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.
authors.affiliation: The Hamlyn Centre, Institute of Global Health Innovation, Imperial College, London, UK; Department of Surgery and Cancer, St Mary's Hospital, Imperial College, London, UK. Electronic address: t.cundy@imperial.ac.uk.
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Cundy
authors.affiliation: Department of Surgery and Cancer, St Mary's Hospital, Imperial College, London, UK.
authors.forename: Leanne
authors.initials: L
authors.lastname: Harling
authors.affiliation: The Hamlyn Centre, Institute of Global Health Innovation, Imperial College, London, UK; Department of Surgery and Cancer, St Mary's Hospital, Imperial College, London, UK.
authors.forename: Hani J
authors.initials: HJ
authors.lastname: Marcus
authors.affiliation: Department of Surgery and Cancer, St Mary's Hospital, Imperial College, London, UK.
authors.forename: Thanos
authors.initials: T
authors.lastname: Athanasiou
authors.affiliation: The Hamlyn Centre, Institute of Global Health Innovation, Imperial College, London, UK; Department of Surgery and Cancer, St Mary's Hospital, Imperial College, London, UK.
authors.forename: Ara W
authors.initials: AW
authors.lastname: Darzi
mesh_terms: D002648:Child; D018662:Fundoplication / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D015233:Models, Statistical; D012371:Robotics; D016896:Treatment Outcome
keywords: Children; Fundoplication; Gastro-esophageal reflux; Laparoscopy; Robot-assisted; Robotic