Robotic Inguinal Hernia Repair for the New Robotic Surgeon-Safety and Early Outcomes in a Large Academic Medical...

Introduction: This work evaluated outcomes of robotic inguinal hernia repair (RIHR) in a single-institution study comparing surgeons with varying robotic experience. Methods: A retrospective study of all patients with RIHR performed between July 2016 and September 2021 at a single institution was performed. Baseline characteristics and outcomes between surgeons with >5 years of robotic experience (ERS) were compared with those with <5 years (NRS). Results: A total of 297 cases of RIHR were performed. Mean age was 58.3 years (standard deviation [SD] 15.3) with a strong male predominance (88.2%). Forty-four patients (14.8%) had a previous repair, 87 (29.3%) underwent bilateral repair, and mean body mass index was 27.7 (SD 4.8). Sixty cases were performed by one ERS surgeon, and the remaining 237 cases were performed by eight NRS. ERS had more recurrent hernias (38.3% versus 8.9%, P < .001), previous abdominal surgery (48% versus 25%, P < .001), and more often had bilateral inguinal hernias (42% versus 26%, P = .018). Incarcerated hernias were more commonly repaired by ERS compared with NRS (35% versus 8.9%, P < .001). Mean operative time was higher for ERS (132.8 minutes versus 106.2, P < .001). ERS was associated with more intraoperative complications (10% versus 0%, P < .001) as well as 30-day complications (6.7% versus 1.7%, P = .033); however, these were of minimal clinical significance. While ERS had a higher rate of radiographical recurrence (6.7% versus 3.0%, P < .001) after 30 days, there was no difference in clinical concern for recurrence. Conclusions: While ERS may approach more complex situations, RIHR is a safe approach for both novice and experienced robotic surgeons.