title: Robot-assisted oesophageal and gastric surgery for benign disease: antireflux operations and Heller's myotomy.
abstract: BACKGROUND
  Robot-assisted general surgery operations are being performed more frequently. This review investigates whether robotic assistance results in significant advantages or disadvantages for the operative treatment of gastro-oesophageal reflux disease and achalasia.
  
  
  METHODS
  The electronic databases (Medline, Embase, PubMed) were searched for original English language publications for antireflux surgery and Heller's myotomy between January 1990 and December 2013.
  
  
  RESULTS
  Thirty-three publications included antireflux operations and 20 included Heller's myotomy. The publications indicate that the safety and effectiveness of robotic surgery is similar to that of conventional minimally invasive surgery for both operations. The six randomized trials of robot-assisted versus laparoscopic antireflux surgery showed no significant advantages but significantly higher costs for the robotic method. Gastric perforation during non-redo robotic fundoplication occurred in four trials.
  
  
  CONCLUSIONS
  No consistent advantage for robot-assisted antireflux surgery has been demonstrated, and there is an increased cost with current robotic technology. A reported advantage for robotic in reducing the perforation rate during Heller's myotomy for achalasia remains unproven. Gastric perforation during robotic fundoplication may be due to the lack of haptic feedback combined with the superhuman strength of the robot.
authors.affiliation: Department of Surgery, St Vincent's Hospital, University of Notre Dame Medical School, Sydney, New South Wales, Australia; Department of Surgery, Lund University and Lund University Hospital (Skane University Hospital), Lund, Sweden.
authors.forename: Dan
authors.initials: D
authors.lastname: Falkenback
authors.forename: Christopher W
authors.initials: CW
authors.lastname: Lehane
authors.forename: Reginald V N
authors.initials: RV
authors.lastname: Lord
mesh_terms: D004931:Esophageal Achalasia / Q000601:surgery*; D049630:Esophageal Sphincter, Lower / Q000601:surgery*; D018662:Fundoplication / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D065287:Robotic Surgical Procedures; D016896:Treatment Outcome
keywords: Heller's myotomy; Nissen fundoplication; antireflux repair; antireflux surgery; laparoscopic surgery; minimally invasive surgery; robot surgery; robot-assisted surgery; robotic surgery; robotic-assisted surgery