Patient-reported outcomes in robotic vs. open transversus abdominis release

Large abdominal wall defects are increasingly repaired robotically using bilateral component separation and myofascial release. Existing studies on complication rates and operative variables fail to capture the patient experience, creating a gap in our understanding of how transversus abdominis releases (TAR) impact quality of life (QoL). Using two validated hernia-specific tools, the Hernia-Related Quality-of-life Survey (HerQLes) and the Carolinas Comfort Scale (CCS), we compared improvements in patient-reported outcomes between the two approaches.

We prospectively enrolled patients undergoing elective bilateral Open (O-TAR) or Robotic (R-TAR) TAR between 2019 and 2023. HerQLes scores 21 days preoperatively and 7, 30, and 180 days postoperatively were collected, as were CCS scores 7, 30, and 180 days postoperative. The primary outcome measure was the mean percent change in HerQLes and CCS scores from pre- to postoperative assessments.

A total of 99 patients consented to participate, with final analysis including those who completed at least one survey: 49 O-TAR and 26 R-TAR. Initial HerQLes scores were significantly higher in the O-TAR cohort (62.95 vs. 48.72, p = 0.001), but both cohorts reported similar total average scores at 6 months (31.4 vs. 24.6, p = 0.29). Mean percent changes in HerQLes scores post-surgery were comparable between groups at 7, 30, and 180 days. Similarly, there were no significant differences in mean percent changes in CCS scores at 30 and 180 days compared to 1-week post-surgery.

Large abdominal wall defects pose QoL restraints on patients, especially those not candidates for minimally invasive repairs. Our data suggest that patients who undergo either open or robotic TAR have significant improvement in reported quality of life. While surgeons should continue to use patient and hernia factors to determine whether patients are candidates for O-TAR or R-TAR, surgeons can assure patients they are likely to have significant improvements in their QOL 6 months after surgery.