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Open versus robotic-assisted transabdominal preperitoneal (R-TAPP) inguinal hernia repair: a multicenter matched analysis of clinical outcomes

Abstract

Purpose

To compare the perioperative outcomes of initial, consecutive robotic-assisted transabdominal preperitoneal (R-TAPP) inguinal hernia repair (IHR) cases with consecutive open cases completed by the same surgeons.

Methods

Multicenter, retrospective, comparative study of perioperative results from open and robotic IHR using standard univariate and multivariate regression analyses for propensity score matched (1:1) cohorts.

Results

Seven general surgeons at six institutions contributed 602 consecutive open IHR and 652 consecutive R-TAPP IHR cases. Baseline patient characteristics in the unmatched groups were similar with the exception of previous abdominal surgery and all baseline characteristics were comparable in the matched cohorts. In matched analyses, postoperative complications prior to discharge were comparable. However, from post discharge through 30 days, fewer patients experienced complications in the R-TAPP group than in the open group [4.3% vs 7.7% (p = 0.047)]. The R-TAPP group had no reoperations post discharge through 30 days of follow-up compared with five patients (1.1%) in the open group (p = 0.062), respectively. Multivariate logistic regression analysis which demonstrated patient age > 65 years and the open approach were risk factors for complications within 30 days post discharge in the matched group [age > 65 years: odds ratio (OR) = 3.33 (95% CI 1.89, 5.87; p < 0.0001); open approach: OR = 1.89 (95% CI 1.05, 3.38; p = 0.031)].

Conclusions

In this matched analysis, R-TAPP provides similar postoperative complications prior to discharge and a lower rate of postoperative complications through 30 days compared to open repair. R-TAPP is a promising and reproducible approach, and may facilitate adoption of minimally invasive repairs of inguinal hernias.

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Acknowledgements

The authors express gratitude to our nurses and physician assistants for their diligence regarding this study and for their care of our patients. The authors would like to thank Usha Kreaden, Principal Biostatistician (Intuitive Surgical) and Dongjing Guo, Senior Biostatistician (Intuitive Surgical) for their statistical review and revision. We thank our patients for giving us the opportunity to provide for their surgical care.

Funding

Study sponsored by Intuitive Surgical, Inc. for data collection, statistical analysis, and editorial support.

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Corresponding author

Correspondence to R. Gamagami.

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Conflict of interest

Drs. Gamagami, Dickens, Gonzalez, D’Amico, Richardson, Rabaza, and Kolachalam received clinical research grants from Intuitive Surgical. Drs. Gamagami, Dickens, Gonzalez, and D’Amico receive personal fees for consulting and education from Intuitive. Dr. Dickens receives personal fees for consulting and education from Covidien and is an advisor (with ownership) to GibLab. Dr. D’Amico receives consulting fees from Ethicon. The authors have no other conflicts of interest or disclosures.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study (Retrospective) formal consent is not required.

Human and animal rights

This article does not contain any studies with animals performed by any of the authors.

Informed consent

For this type of study (Retrospective) formal consent is not required.

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Gamagami, R., Dickens, E., Gonzalez, A. et al. Open versus robotic-assisted transabdominal preperitoneal (R-TAPP) inguinal hernia repair: a multicenter matched analysis of clinical outcomes. Hernia 22, 827–836 (2018). https://doi.org/10.1007/s10029-018-1769-1

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Keywords

  • Robotic
  • Open
  • Inguinal hernia repair
  • TAPP