A systematic review of robot-assisted anti-reflux surgery to examine reporting standards

RoboSurg collaborative group, Marc M. Huttman, Harry F. Robertson, Alexander N. Smith, Sarah E. Biggs, Ffion Dewi, Lauren K. Dixon, Emily N. Kirkham, Conor S. Jones, Jozel Ramirez, Darren L. Scroggie, Benjamin E. Zucker, Samir Pathak, Natalie S. Blencowe*

*Corresponding author for this work

Research output: Contribution to journalReview article (Academic Journal)peer-review

3 Citations (Scopus)
29 Downloads (Pure)


Robot-assisted anti-reflux surgery (RA-ARS) is increasingly being used to treat refractory gastro-oesophageal reflux disease. The IDEAL (Idea, Development, Exploration, Assessment, Long-term follow up) Collaboration’s framework aims to improve the evaluation of surgical innovation, but the extent to which the evolution of RA-ARS has followed this model is unclear. This study aims to evaluate the standard to which RA-ARS has been reported during its evolution, in relation to the IDEAL framework. A systematic review from inception to June 2020 was undertaken to identify all primary English language studies pertaining to RA-ARS. Studies of paraoesophageal or giant hernias were excluded. Data extraction was informed by IDEAL guidelines and summarised by narrative synthesis. Twenty-three studies were included: two case reports, five case series, ten cohort studies and six randomised controlled trials. The majority were single-centre studies comparing RA-ARS and laparoscopic Nissen fundoplication. Eleven (48%) studies reported patient selection criteria, with high variability between studies. Few studies reported conflicts of interest (30%), funding arrangements (26%), or surgeons’ prior robotic experience (13%). Outcome reporting was heterogeneous; 157 distinct outcomes were identified. No single outcome was reported in all studies.The under-reporting of important aspects of study design and high degree of outcome heterogeneity impedes the ability to draw meaningful conclusions from the body of evidence. There is a need for further well-designed prospective studies and randomised trials, alongside agreement about outcome selection, measurement and reporting for future RA-ARS studies.

Original languageEnglish
Pages (from-to)313-324
Number of pages12
JournalJournal of Robotic Surgery
Issue number2
Early online date8 Sept 2022
Publication statusPublished - 1 Apr 2023

Bibliographical note

Funding Information:
Fourteen articles (74%) reported institutional review board (IRB) or ethics committee approval. Three authors reported exemptions, although reasons were not provided. Fifteen studies (65%) reported obtaining consent from the included patients, of which one specifically documented the innovative nature of the RA-ARS. Sixteen articles (70%) did not include statements regarding COI. Two COI were declared: one author founded a robotics company [], and another received honoraria for speaking on behalf of device companies[]. Seventeen studies (74%) did not report whether funding was received and four (17%) stated that no funding was provided. One study received funding from the authors’ local department [], and one from a medical device company [].

Funding Information:
DS, RM, SC, NB and JMB were supported by the NIHR Bristol Biomedical Research Centre.

Publisher Copyright:
© 2022, The Author(s).


  • Anti-reflux surgery
  • Fundoplication
  • IDEAL framework
  • Outcome reporting
  • Robotic surgery


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