Robot-assisted abdominal wall surgery: a systematic review of the literature and meta-analysis
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The number of robot-assisted hernia repairs is increasing, but the potential benefits have not been well described. The aim of this study was to evaluate the available literature reporting on outcomes after robot-assisted hernia repairs.
This is a qualitative review and meta-analysis of papers evaluating short-term outcomes after inguinal or ventral robot-assisted hernia repair compared with either open or laparoscopic approach. The primary outcome was postoperative complications and secondary outcomes were duration of surgery, postoperative length of stay and financial costs.
Fifteen studies were included. Postoperative complications were significantly decreased after robot-assisted inguinal hernia repair compared with open repair. There were no differences in complications between robot-assisted and laparoscopic inguinal hernia repair. For ventral hernia repair, sutured closure of the defect, retromuscular mesh placement and transversus abdominis release is feasible when using the robot. Length of stay was decreased by a mean of 3 days for robot-assisted repairs compared with open approach. There were no differences in postoperative complications and the operative time was significantly longer for robot-assisted ventral hernia repair compared with laparoscopic or open approach.
For ventral hernias that would normally require an open procedure, a robot-assisted repair may be a good option, as the use of a minimally invasive approach for these procedures decreases length of stay significantly. For inguinal hernias, the benefit of the robot is questionable. Randomized controlled trials and prospective studies are needed.
KeywordsVentral hernia Inguinal hernia Postoperative complication Outcome Length of stay Cost
Compliance with ethical standards
Conflict of interest
NAH and KKJ declare no conflicts of interest. FM declares conflict of interest not directly related to the submitted work; grants and personal fees from Medtronic and Dynamesh and personal fees from Intuitive Surgical, CMR Surgical and Bard Davol, no funding was received for the current work.
Approval from the institutional review board was not required for this study.
Human and animal rights
This article does not contain any studies with human participants or animals performed by any of the authors.
For this retrospective review, formal consent is not required
- 2.Huang X, Wang L, Zheng X, Wang X (2017) Comparison of perioperative, functional, and oncologic outcomes between standard laparoscopic and robotic-assisted radical prostatectomy: a systemic review and meta-analysis. Surg Endosc 31(3):1045–1060. https://doi.org/10.1007/s00464-016-5125-1 CrossRefPubMedGoogle Scholar
- 8.Kudsi OY, McCarty JC, Paluvoi N, Mabardy AS (2017) Transition from laparoscopic totally extraperitoneal inguinal hernia repair to robotic transabdominal preperitoneal inguinal hernia repair: a retrospective review of a single surgeon’s experience. World J Surg. https://doi.org/10.1007/s00268-017-3998-3 PubMedGoogle Scholar
- 12.Bittner Iv JG, Cesnik LW, Kirwan T, Wolf L, Guo D (2018) Patient perceptions of acute pain and activity disruption following inguinal hernia repair: a propensity-matched comparison of robotic-assisted, laparoscopic, and open approaches. J Robot Surg. https://doi.org/10.1007/s11701-018-0790-9 PubMedCentralGoogle Scholar
- 14.Prabhu AS, Dickens EO, Copper CM, Mann JW, Yunis JP, Phillips S, Huang LC, Poulose BK, Rosen MJ (2017) Laparoscopic vs robotic intraperitoneal mesh repair for incisional hernia: an americas hernia society quality collaborative analysis. J Am Coll Surg. https://doi.org/10.1016/j.jamcollsurg.2017.04.011 Google Scholar
- 15.Gonzalez AM, Romero RJ, Seetharamaiah R, Gallas M, Lamoureux J, Rabaza JR (2015) Laparoscopic ventral hernia repair with primary closure versus no primary closure of the defect: potential benefits of the robotic technology. Int J Med Robot 11(2):120–125. https://doi.org/10.1002/rcs.1605 CrossRefPubMedGoogle Scholar
- 17.Walker PA, May AC, Mo J, Cherla DV, Santillan MR, Kim S, Ryan H, Shah SK, Wilson EB, Tsuda S (2018) Multicenter review of robotic versus laparoscopic ventral hernia repair: is there a role for robotics? Surg Endosc 32(4):1901–1905. https://doi.org/10.1007/s00464-017-5882-5 CrossRefPubMedGoogle Scholar
- 18.Carbonell AM, Warren JA, Prabhu AS, Ballecer CD, Janczyk RJ, Herrera J, Huang LC, Phillips S, Rosen MJ, Poulose BK (2017) Reducing length of stay using a robotic-assisted approach for retromuscular ventral hernia repair: a comparative analysis from the Americas Hernia Society Quality Collaborative. Ann Surg. https://doi.org/10.1097/SLA.0000000000002244 PubMedGoogle Scholar
- 22.Scheuermann U, Niebisch S, Lyros O, Jansen-Winkeln B, Gockel I (2017) Transabdominal preperitoneal (TAPP) versus Lichtenstein operation for primary inguinal hernia repair—a systematic review and meta-analysis of randomized controlled trials. BMC Surg 17(1):55. https://doi.org/10.1186/s12893-017-0253-7 CrossRefPubMedPubMedCentralGoogle Scholar
- 27.Kudsi OY, McCarty JC, Paluvoi N, Mabardy AS (2017) Transition from laparoscopic totally extraperitoneal inguinal hernia repair to robotic transabdominal preperitoneal inguinal hernia repair: a retrospective review of a single surgeon’s experience. World J Surg 41(9):2251–2257. https://doi.org/10.1007/s00268-017-3998-3 CrossRefPubMedGoogle Scholar