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Robotic-assisted versus laparoscopic incisional hernia repair: a systematic review and meta-analysis

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Abstract

Purpose

This study aimed to perform a systematic review and meta-analysis comparing the efficacy and safety outcomes of robotic-assisted and laparoscopic techniques for incisional hernia repair.

Methods

PubMed, Embase, Scopus, Cochrane databases, and conference abstracts were systematically searched for studies that directly compared robot-assisted versus laparoscopy for incisional hernia repair and reported safety or efficacy outcomes in a follow-up of ≥ 1 month. The primary endpoints of interest were postoperative complications and the length of hospital stay.

Results

The search strategy yielded 2104 results, of which four studies met the inclusion criteria. The studies included 1293 patients with incisional hernia repairs, 440 (34%) of whom underwent robot-assisted repair. Study follow-up ranged from 1 to 24 months. There was no significant difference between groups in the incidence of postoperative complications (OR 0.65; 95% CI 0.35–1.21; p = 0.17). The recurrence rate of incisional hernias (OR 0.34; 95% CI 0.05–2.29; p = 0.27) was also similar between robotic and laparoscopic surgeries. Hospital length of stay (MD − 1.05 days; 95% CI − 2.06, − 0.04; p = 0.04) was significantly reduced in the robotic-assisted repair. However, the robot-assisted repair had a significantly longer operative time (MD 69.6 min; 95% CI 59.0–80.1; p < 0.001).

Conclusion

The robotic approach for incisional hernia repair was associated with a significant difference between the two groups in complications and recurrence rates, a longer operative time than laparoscopic repair, but with a shorter length of stay.

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Data availability

Data are available upon a reasonable request to the corresponding author.

Abbreviations

BMI:

Body mass index

LIHR:

Laparoscopic incisional hernia repair

MD:

Mean difference

OR:

Odds-ratio

PRISMA:

Preferred Reporting Items for Systematic Reviews and Meta-Analysis

PROSPERO:

International Prospective Register of Systematic Reviews

RCT:

Randomized controlled trial

RIHR:

Robotic-assisted incisional hernia repair

RoB-2:

Cochrane risk-of-bias tool for randomized trials

ROBINS-I:

Cochrane risk-of-bias in non-randomized studies of interventions

LOS:

Length of stay

CI:

Confidence interval

IPOM:

Intraperitoneal onlay mesh

LIPOM:

Laparoscopic intraperitoneal onlay mesh

rIPOM:

Robotic intraperitoneal onlay mesh

rTAPP:

Robotic trans-abdominal preperitoneal

TAR:

Transversus abdominis release

TAPP:

Trans-abdominal preperitoneal

LTAPP:

Laparoscopic trans-abdominal preperitoneal

eTEP:

Enhanced-view totally extraperitoneal

PPOM:

Pre-peritoneal onlay mesh

MILOS:

Mini or less open sublay repair

eMILOS:

Endoscopic MILOS

NOTES:

Natural orifice transluminal endoscopic surgery

eTEP-RS:

Enhanced-view totally extraperitoneal Rives-Stoppa

ASA:

American Society of Anesthesiologists

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Funding

The study did not receive support or grants from companies, research centers, or universities. The authors did not receive grant support from companies, research centers, universities, or from the state. We declare that the authors are willing to cover the possible costs of color reproduction.

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Authors and Affiliations

  1. Department of Surgery, University of Cuenca, Cuenca, Ecuador

    J. A. R. Peñafiel

  2. Health Sciences Faculty, Universidad Internacional, Quito, Ecuador

    J. A. R. Peñafiel

  3. Department of Mathematics, University Central of Ecuador, Quito, Ecuador

    G. Valladares

  4. Department of Medicine, Positivo University, Curitiba, Brazil

    Amanda Cyntia Lima Fonseca Rodrigues

  5. Department of Statistics and Biostatistics, Anhembi Morumbi University, Curitiba, Brazil

    Amanda Cyntia Lima Fonseca Rodrigues

  6. Department of Surgery, Federal University of Rio Grande do Norte, Natal, Brazil

    P. Avelino

  7. Department of Surgery, Federal University of Minas Gerais, Belo Horizonte, Brazil

    L. Amorim

  8. Department of Surgery, University of UniEvangelica, Anapolis, Brazil

    L. Teixeira

  9. Department of Surgery, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Brazil

    G. Brandao

  10. Department of Surgery, Instituto Tocantinense Presidente Antônio Carlos, Palmas, Tocantins, Brazil

    F. Rosa

  11. Francisco Viteri and Gato Sobral, Universidad Central of Ecuador, Campus Universitario, Pichincha, Ecuador

    G. Valladares

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Peñafiel, J.A.R., Valladares, G., Cyntia Lima Fonseca Rodrigues, A. et al. Robotic-assisted versus laparoscopic incisional hernia repair: a systematic review and meta-analysis. Hernia 28, 321–332 (2024). https://doi.org/10.1007/s10029-023-02881-1

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