Robot-Assisted Antireflux Surgery in Gastro-Oesophageal Reflux Disease and Hiatal Hernia: Beyond Platform Comparison Towards Selective Clinical Value.

INTRODUCTION: Contemporary gastro-oesophageal reflux disease (GERD) management increasingly relies on objective diagnosis and phenotype-based treatment selection, prompting reassessment of robot-assisted antireflux surgery beyond simple comparison with laparoscopy. METHODS: A narrative review of PubMed/MEDLINE, Web of Science and guideline-based sources addressing robotic antireflux and hiatal hernia surgery, with emphasis on case complexity, reconstructive demands and recent comparative evidence. RESULTS: Robotic surgery appears safe and feasible, with perioperative outcomes and mid-term symptom control generally comparable to those of laparoscopy. Superiority in routine primary procedures remains unproven, whereas potential advantages appear more relevant in giant or paraoesophageal hernia (PEH) repair, revisional foregut surgery, complex mediastinal dissection and demanding hiatal reconstruction. CONCLUSIONS: Robot-assisted antireflux surgery should be viewed as a selectively deployed precision platform for complex foregut reconstruction rather than as a universal alternative to laparoscopy.