Costing methodologies in robotic ventral hernia repair: a scoping review

The financial aspects of robotic minimally invasive surgery (RMIS) remain controversial, with conflicting evidence regarding its cost compared to laparoscopic and open techniques, particularly in ventral hernia repair. This scoping review aims to systematically map the existing literature on robotic-assisted ventral hernia repair (rVHR) costs, the methodologies used in cost reporting, and explore how these methodological choices affect the validity of conclusions.

Following Joanna Briggs Institute and PRISMA-ScR guidelines, we conducted a systematic search in Ovid EMBASE, Ovid MEDLINE, and Cochrane CENTRAL. We included studies reporting rVHR costs. Two independent researchers screened records and extracted data on study characteristics, costing methodology, perspectives, and costs.

Of the 4,856 screened records, 43 were included. The majority (74%) originated from the United States, and 95% consisted of basic cost-comparison studies with no full economic evaluations. Forty-two percent relied on hospital charges, while only 23% employed a top-down and/or bottom-up costing methodology. Seventy-seven percent of the studies adopted a hospital perspective, while 12% used a payer perspective. Among 36 studies comparing rVHR with non-robotic techniques, 49% found nonrobotic surgery to be less costly, 22% favored robotic surgery, and 29% found no significant cost difference. Cost breakdowns were inconsistently reported, with key components such as robotic system acquisition frequently omitted.

This review exposes a critical gap in the financial evidence surrounding rVHR. The absence of standardized costing methodology, reliance on partial economic evaluations, and inconsistent inclusion of key cost components limit the ability to assess the broader economic impact of rVHR. Standardized guidelines tailored to RMIS are needed to improve transparency, reproducibility, and validity in future economic evaluations.