, Volume 23, Issue 1, pp 17–27 | Cite as

Robot-assisted abdominal wall surgery: a systematic review of the literature and meta-analysis

  • N. A. HenriksenEmail author
  • K. K. Jensen
  • F. Muysoms



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.


Ventral 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.

Ethical approval

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.

Informed consent

For this retrospective review, formal consent is not required


  1. 1.
    Telem DA (2018) Is robotic surgery the future for abdominal wall hernia repair? Not so fast. Ann Surg 267(2):218–219. CrossRefPubMedGoogle Scholar
  2. 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. CrossRefPubMedGoogle Scholar
  3. 3.
    Coakley KM, Sims SM, Prasad T, Lincourt AE, Augenstein VA, Sing RF, Heniford BT, Colavita PD (2017) A nationwide evaluation of robotic ventral hernia surgery. Am J Surg 214(6):1158–1163. CrossRefPubMedGoogle Scholar
  4. 4.
    Bittner JG, Alrefai S, Vy M, Mabe M, Del Prado PAR, Clingempeel NL (2017) Comparative analysis of open and robotic transversus abdominis release for ventral hernia repair. Surg Endosc. Google Scholar
  5. 5.
    Sanchez A, Rodriguez O, Jara G, Sanchez R, Vegas L, Rosciano J, Estrada L (2018) Robot-assisted surgery and incisional hernia: a comparative study of ergonomics in a training model. J Robot Surg. Google Scholar
  6. 6.
  7. 7.
    Charles EJ, Mehaffey JH, Tache-Leon CA, Hallowell PT, Sawyer RG, Yang Z (2017) Inguinal hernia repair: is there a benefit to using the robot? Surg Endosc. PubMedCentralGoogle Scholar
  8. 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. PubMedGoogle Scholar
  9. 9.
    Tran H (2011) Robotic single-port hernia surgery. J Soc Laparoendosc Surg 15(3):309–314. CrossRefGoogle Scholar
  10. 10.
    Waite KE, Herman MA, Doyle PJ (2016) Comparison of robotic versus laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair. J Robot Surg 10(3):239–244. CrossRefPubMedGoogle Scholar
  11. 11.
    Kolachalam R, Dickens E, D’Amico L, Richardson C, Rabaza J, Gamagami R, Gonzalez A (2017) Early outcomes of robotic-assisted inguinal hernia repair in obese patients: a multi-institutional, retrospective study. Surg Endosc. PubMedGoogle Scholar
  12. 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. PubMedCentralGoogle Scholar
  13. 13.
    Armijo P, Pratap A, Wang Y, Shostrom V, Oleynikov D (2017) Robotic ventral hernia repair is not superior to laparoscopic: a national database review. Surg Endosc. Google Scholar
  14. 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. Google Scholar
  15. 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. CrossRefPubMedGoogle Scholar
  16. 16.
    Chen YJ, Huynh D, Nguyen S, Chin E, Divino C, Zhang L (2017) Outcomes of robot-assisted versus laparoscopic repair of small-sized ventral hernias. Surg Endosc 31(3):1275–1279. CrossRefPubMedGoogle Scholar
  17. 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. CrossRefPubMedGoogle Scholar
  18. 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. PubMedGoogle Scholar
  19. 19.
    Warren JA, Cobb WS, Ewing JA, Carbonell AM (2017) Standard laparoscopic versus robotic retromuscular ventral hernia repair. Surg Endosc 31(1):324–332. CrossRefPubMedGoogle Scholar
  20. 20.
    Martin-Del-Campo LA, Weltz AS, Belyansky I, Novitsky YW (2018) Comparative analysis of perioperative outcomes of robotic versus open transversus abdominis release. Surg Endosc 32(2):840–845. CrossRefPubMedGoogle Scholar
  21. 21.
    Tran H (2011) Safety and efficacy of single incision laparoscopic surgery for total extraperitoneal inguinal hernia repair. J Soc Laparoendosc Surg 15(1):47–52. CrossRefGoogle Scholar
  22. 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. CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Baker JJ, Oberg S, Andresen K, Klausen TW, Rosenberg J (2018) Systematic review and network meta-analysis of methods of mesh fixation during laparoscopic ventral hernia repair. Br J Surg 105(1):37–47. CrossRefPubMedGoogle Scholar
  24. 24.
    Tandon A, Pathak S, Lyons NJ, Nunes QM, Daniels IR, Smart NJ (2016) Meta-analysis of closure of the fascial defect during laparoscopic incisional and ventral hernia repair. Br J Surg 103(12):1598–1607. CrossRefPubMedGoogle Scholar
  25. 25.
    Belyansky I, Zahiri HR, Park A (2016) Laparoscopic transversus abdominis release, a novel minimally invasive approach to complex abdominal wall reconstruction. Surg Innov 23(2):134–141. CrossRefPubMedGoogle Scholar
  26. 26.
    Turchetti G, Palla I, Pierotti F, Cuschieri A (2012) Economic evaluation of da Vinci-assisted robotic surgery: a systematic review. Surg Endosc 26(3):598–606. CrossRefPubMedGoogle Scholar
  27. 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. CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of SurgeryZealand University HospitalKoegeDenmark
  2. 2.Digestive Disease CenterBispebjerg University HospitalCopenhagenDenmark
  3. 3.Department of Suregery, Maria MiddelaresGhentBelgium

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