# The Implementation of Robotics in the Setting of Hiatal Hernia Repair: A Scoping Review on Current Evidence

## TL;DR

This review compares robotic and laparoscopic methods for hiatal hernia repair, finding similar safety and outcomes but higher costs for robotic surgery.

## Contribution

A scoping review analyzing current evidence on robotic hiatal hernia repair, highlighting its safety, feasibility, and cost implications.

## Key findings

- Robotic hiatal hernia repair shows safety and efficacy comparable to laparoscopic methods.
- Robotic techniques are associated with lower blood loss and fewer transfusions.
- Higher costs and a learning curve are notable challenges for robotic procedures.

## Abstract

Background and objective:For many years, laparoscopy has been recognized as the standard approach for treating hiatal hernia (HH). Nevertheless, it continues to face significant recurrence rates and specific technical challenges. With the swift advancement of technology and the gradual adoption of robotic systems in clinical practice, robotic HH repair has generated interest due to its potential advantages, including three-dimensional visualization, improved dexterity, and better ergonomics. This scoping review seeks to assess the safety, feasibility, and effectiveness of robotic HH repair.

Material and methods: A thorough literature search was performed in the PubMed and Scopus databases between August 13 and October 1, 2025, adhering to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) criteria and utilizing the keywords "Robotic AND Hiatal Hernia AND Repair." The focus was on studies published from 2015 onwards. In total, 31 studies are included in this review.

Results: Evidence shows that robotic HH repair exhibits safety and efficacy levels comparable to those of the laparoscopic method across existing studies. Procedure duration varied depending on the surgeon’s experience with robotic tools, while the length of stay (LOS) at the hospital was often comparable to or occasionally shorter in robotic cases. Both approaches showed similar rates of postoperative complications and recurrences. Multiple studies indicated that robotic techniques resulted in lower blood loss and fewer transfusions, with one investigation highlighting reduced recovery times associated with robotic repair, especially for overweight and obese patients. However, robotic procedures consistently incurred higher costs. Notably, one study showed improved operative efficiency after seven to 15 surgeries as part of the learning curve.

Conclusions: Available literature indicates that robotic HH repair serves as a safe and practical alternative to laparoscopy, offering enhanced visualization and accuracy with similar outcomes. While there is encouraging data, the elevated costs and the scarcity of long-term randomized studies indicate a need for further investigation to identify the most effective surgical strategy.