Robotic inguinal and umbilical hernia repair: clinical outcomes, costs, and future perspectives: a narrative review

Robotic-assisted surgery (RAS) has rapidly expanded into abdominal wall procedures, including inguinal and umbilical hernia repair. It offers improved ergonomics, three-dimensional visualization, and enhanced dexterity. However, its role in routine hernia surgery remains debatable, particularly in terms of cost-effectiveness and patient outcomes. A narrative review of recently published systematic reviews, meta-analyses, randomized trials, and economic evaluations (2020-2025) was conducted. Evidence was synthesized to compare the clinical outcomes, perioperative metrics, and costs of the robotic, laparoscopic, and open techniques. RAS is associated with higher procedural costs, adding approximately USD 3000-5000 per inguinal hernia repair compared to laparoscopy, and total costs of USD 8000-12,000 for umbilical hernia repair. Incremental cost-effectiveness ratios often exceed commonly accepted thresholds in current healthcare settings. Clinical outcomes reveal modest advantages, such as small reductions in early postoperative pain and a slightly earlier return to work, while complication and recurrence rates remain comparable to those of laparoscopy. Prolonged operative times, particularly during the learning curve, further increase the perioperative costs. Cost savings appear achievable only in high-volume centers with optimized team training. RAS represents a technological advance in hernia surgery, supported by structured educational programs and emerging innovations such as AI and augmented reality. In routine uncomplicated hernias, current evidence suggests only limited incremental benefits relative to the additional costs. Caution and selective adoption in anatomically complex or recurrent cases have been proposed, but require further validation through high-quality studies. Ongoing research, technological refinement, and reduction of system costs may progressively enhance the role of robotics in abdominal wall surgery.