Does robotic surgery have a role in abdominal wall reconstruction? A systematic review and meta-analysis

Robotic or robotic assisted surgery offers notable advantages in the operating theatre, particularly improved ergonomics and reduced mental and physical workload compared to laparoscopic surgery. This review assessed the feasibility of robotic surgery in abdominal wall reconstruction and hernia repair, as well as the barriers to clinical implementation and training. Conducted in accordance with preferred reporting items for systematic reviews and meta-analyses guidelines, this systematic review included a literature search of PubMed, Medline, and Embase databases. Descriptive synthesis and mixed fixed/random effects meta-analysis were performed, with unpaired t-tests used for nonparametric data. A total of 110 clinical and 4 educational articles were reviewed. Robotic surgery was associated with longer operative times than laparoscopic and open approaches, though steep learning curves were commonly reported. However, robotic surgery showed a significantly shorter hospital stay (mean difference: -1.59 days, 95% CI: -1.89 to -1.30) and fewer complications compared to open surgery (OR: 0.75, 95% CI: 0.56-1.01). When compared with laparoscopic surgery, robotic procedures showed a trend towards fewer complications (OR: 0.87, 95% CI: 0.56-1.37). Although robotic procedures incur higher costs than laparoscopic surgery, the overall cost may be balanced by faster recovery and fewer complications when compared to open surgery. In conclusion, robotic and robotic assisted surgery are technically feasible and safe for abdominal wall reconstruction. Further high-quality comparative studies, especially against laparoscopic surgery, are needed to justify higher costs and fully evaluate the patient care benefits.