Robotic eTEP versus IPOM evaluation: the REVEAL multicenter randomized clinical trial

Area of Science:

• Minimally Invasive Surgery
• Surgical Technology
• Hernia Repair

Background:

• Robotic intraperitoneal onlay mesh (rIPOM) and enhanced-view totally extraperitoneal (eTEP) are robotic techniques for ventral hernia repair.
• The study investigated if avoiding mesh fixation in eTEP reduces postoperative pain compared to rIPOM.

Purpose of the Study:

• To compare early postoperative pain between robotic eTEP and rIPOM for ventral hernia repair.
• To evaluate secondary outcomes including length of stay, opioid consumption, and quality of life.

Main Methods:

• A multi-center, randomized clinical trial involving 100 patients with midline ventral hernias (≤7 cm).
• Patients were randomized to either rIPOM or robotic eTEP.
• Primary outcome was postoperative pain on the first day; secondary outcomes included same-day discharge, length of stay, opioid use, and quality of life.

Main Results:

• Postoperative pain on the first day was similar between rIPOM and eTEP groups (p=0.66).
• No significant differences were observed in pain at other time points, same-day discharge, length of stay, or quality of life.
• rIPOM demonstrated significantly shorter operative times (p<0.001), reduced surgeon workload (p<0.001), and fewer surgical site occurrences (p=0.004) compared to eTEP.

Conclusions:

• Avoiding mesh fixation in robotic eTEP did not provide a significant advantage in early postoperative pain compared to rIPOM.
• rIPOM offers benefits of shorter operative time and reduced surgeon workload, making it a favorable option for ventral hernia repair.