Abstract
Purpose
To compare outcomes of robotic and open repair for uncomplicated, moderate-sized, midline ventral hernias.
Methods
From 2017 to 2021, patient characteristics and 30 day outcomes for all ventral hernias at our center were prospectively collected. We studied hernias potentially suitable for robotic repair: elective, midline, 3–10 cm rectus separation, no prior mesh, and no need for concomitant procedure. Robotic or open repair was performed by surgeon or patient preference. The primary outcome was any complication using Clavien–Dindo scoring. Secondary outcomes were operative time, length-of-stay, and readmissions. Regression identified predictors of complications.
Results
Of 648 hernias repaired, 70 robotic and 52 open repairs met inclusion criteria. The groups had similar patient demographics, co-morbidities, and hernia size, except that there were more immunosuppressed patients in the open group (11 versus 5 patients, p = 0.031). Complications occurred after 7 (13%) open repairs versus 2 (3%) robotic repairs, p = 0.036. Surgical site infection occurred after four open repairs but no robotic repair, p = 0.004. Length-of-stay averaged almost 3 days longer after open repair (4.3 ± 2.7 days versus 1.5 ± 1.4 days, p = 0.031). Readmission occurred after 6 (12%) oppen repairs but only 1 (1%) robotic repair. A long-term survey (61% response rate after mean follow-up of 2.8 years) showed that the HerQLes QOL score was better after robotic repair (46 ± 15 versus 40 ± 17, = 0.049). In regression models, only open technique predicted complications.
Conclusions
Robotic techniques were associated with fewer complications, shorter hospitalization, fewer infections, and fewer readmissions compared to open techniques. Open surgical technique was the only predictor of complications.
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Data availability
Data supporting this study are not available because NSQIP does not provide the geneal public with center-specific outcome data, according to NSQIP's data use policy.
References
Sheetz KH, Claflin J, Dimick JB (2020) Trends in the adoption of robotic surgery for common surgical procedures. JAMA Netw Open 3:e1918911. https://doi.org/10.1001/jamanetworkopen.2019.18911
Coakley KM, Sims SM, Prasad T et al (2017) A nationwide evaluation of robotic ventral hernia surgery. Am J Surg 214:1158–1163. https://doi.org/10.1016/j.amjsurg.2017.08.022
Madion M, Goldblatt MI, Gould JC, Higgins RM (2021) Ten-year trends in minimally invasive hernia repair: a NSQIP database review. Surg Endosc 35:7200–7208. https://doi.org/10.1007/s00464-020-08217-9
Olavarria OA, Bernardi K, Shah SK et al (2020) Robotic versus laparoscopic ventral hernia repair: multicenter, blinded randomized controlled trial. BMJ 370:m2457. https://doi.org/10.1136/bmj.m2457
Petro CC, Zolin S, Krpata D et al (2021) Patient-reported outcomes of robotic vs laparoscopic ventral hernia repair with intraperitoneal mesh: the prove-it randomized clinical trial. JAMA Surg 156:22–29. https://doi.org/10.1001/jamasurg.2020.4569
Petro CC, Thomas JD, Tu C et al (2022) Robotic vs laparoscopic ventral hernia repair with intraperitoneal mesh: 1 year exploratory outcomes of the prove-it randomized clinical trial. J Am Coll Surg 234:1160–1165. https://doi.org/10.1097/XCS.0000000000000171
Armijo P, Pratap A, Wang Y et al (2018) Robotic ventral hernia repair is not superior to laparoscopic: a national database review. Surg Endosc 32:1834–1839. https://doi.org/10.1007/s00464-017-5872-7
LeBlanc KA, Gonzalez A, Dickens E et al (2021) Robotic-assisted, laparoscopic, and open incisional hernia repair: early outcomes from the prospective hernia study. Hernia 25:1071–1082. https://doi.org/10.1007/s10029-021-02381-0
Bittner JG, Alrefai S, Vy M et al (2018) Comparative analysis of open and robotic transversus abdominis release for ventral hernia repair. Surg Endosc 32:727–734. https://doi.org/10.1007/s00464-017-5729-0
Guzman-Pruneda A, F, Huang L-C, Collins C, et al (2021) Abdominal core quality of life after ventral hernia repair: a comparison of open versus robotic-assisted retromuscular techniques. Surg Endosc. https://doi.org/10.1007/s00464-020-07386-x
Kudsi OY, Kaoukabani G, Bou-Ayash N et al (2023) A comparison of clinical outcomes and costs between robotic and open ventral hernia repair. Am J Surg 226:87–92. https://doi.org/10.1016/j.amjsurg.2023.01.031
Nguyen B, David B, Shiozaki T et al (2021) Comparisons of abdominal wall reconstruction for ventral hernia repairs, open versus robotic. Sci Rep 11:8086. https://doi.org/10.1038/s41598-021-86093-6
Bracale U, Corcione F, Neola D et al (2021) Transversus abdominis release (TAR) for ventral hernia repair: open or robotic? Short-term outcomes from a systematic review with meta-analysis. Hernia 25:1471–1480. https://doi.org/10.1007/s10029-021-02487-5
Collins CE, Renshaw S, Huang L-C et al (2023) Robotic vs. open approach for older adults undergoing retromuscular ventral hernia repair. Ann Surg 277:697–703. https://doi.org/10.1097/SLA.0000000000005260
Kanters AE, Krpata DM, Blatnik JA et al (2012) Modified hernia grading scale to stratify surgical site occurrence after open ventral hernia repairs. J Am Coll Surg 215:787–793. https://doi.org/10.1016/j.jamcollsurg.2012.08.012
Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chron Dis 40:373–383. https://doi.org/10.1016/0021-9681(87)90171-8
Dindo D, Demartines N, Clavien P-A (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213. https://doi.org/10.1097/01.sla.0000133083.54934.ae
Krpata DM, Schmotzer BJ, Flocke S et al (2012) Design and initial implementation of HerQLes: a hernia-related quality-of-life survey to assess abdominal wall function. J Am Coll Surg 215:635–642. https://doi.org/10.1016/j.jamcollsurg.2012.06.412
Kudsi OY, Gokcal F, Bou-Ayash N, Chang K (2021) Comparison of midterm outcomes between open and robotic emergent ventral hernia repair. Surg Innov 28:449–457. https://doi.org/10.1177/1553350620971182
Ye L, Childers CP, de Virgilio M et al (2021) Clinical outcomes and cost of robotic ventral hernia repair: systematic review. BJS Open. https://doi.org/10.1093/bjsopen/zrab098
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We thank Pamela Derish for copyediting the manuscript
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FA, JJ, and MA conducted the chart review and patient surveys. FA and JC performed statistical analysis. FA, ML, CL, IA, and JC performed manuscript writing and editing.
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Carter, J., Ahamed, F., Juprasert, J. et al. Robotic repair of moderate-sized midline ventral hernias reduced complications, readmissions, and length of hospitalization compared to open techniques. J Robotic Surg 18, 142 (2024). https://doi.org/10.1007/s11701-024-01909-7
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DOI: https://doi.org/10.1007/s11701-024-01909-7