Great Debates-Two Hands Versus Four: Open Abdominal Wall Reconstruction (AWR) Versus Robotic-Assisted AWR

Abdominal wall reconstruction (AWR) represents a heterogeneous spectrum of operations, ranging from simple ventral hernia repairs to more complex hernia with loss of abdominal wall domain. Historically, AWR has been performed via the open approach, and eventually it was also performed via minimally invasive approaches with advancements in laparoscopic surgery. Compared to open AWR, laparoscopic AWR provided advantages of being less invasive, shorter hospital stays, and improved patient outcomes. With the emergence of robotic surgery, AWR has been increasingly performed via robotic approach, given that it provides all the advantages of laparoscopic AWR as well as better precision and superior surgeon ergonomics. However, robotic AWR can often be expensive, especially with high acquisition costs and longer operative times. Furthermore, data on long-term outcomes after robotic AWR do not yet clearly demonstrate its benefits. While open AWR remains the classic and widely available approach, robotic AWR is a promising approach with significant potential benefits. Ultimately, the best approach to AWR depends on thoughtful patient selection, access, and surgeons' technical capabilities and familiarity.