Robotic Inguinal Hernia: The Why and the Hows

Abstract

Robotic inguinal hernia is a controversial topic. The use of a robotic platform to perform a minimally invasive, preperitoneal hernia repair builds on the 20-year debate between traditional open versus laparoscopic inguinal hernia. In 2018, 80% of all inguinal hernia are repaired using an open technique, despite two decades of training and experience with laparoscopic inguinal hernia surgery. The robotic technique is based on the well-delineated transabdominal preperitoneal (TAPP) laparoscopic inguinal hernia repair. The lack of adoption of minimally invasive (MIS) techniques in inguinal hernia runs counter to trends of MIS increased adoption for procedures such as appendectomy, colectomy, cholecystectomy, and even ventral hernia. One would expect that adding more potential cost to the high cost of a laparoscopic inguinal repair would decrease the perceived value of the robotic inguinal hernia. This does not appear to be the case, as early trends are showing migration of both open and laparoscopic surgeons to the robotic platform. The central questions this chapter will address are how can the cost of robotic inguinal hernia surgery be minimized and in which patient population does the value proposition become positive.