Robotic versus laparoscopic elective inguinal hernia repair: a NSQIP study Robotl hernia repair: a NSQIP studyic vs....

The aim of this study was to compare robotic-assisted versus laparoscopic techniques in elective primary minimally invasive inguinal hernia repair, focusing on intraoperative conversion rates, perioperative outcomes, and preoperative risk factors. Given the increasing adoption of robotic surgery, we sought to evaluate whether the proposed technical advantages translate into measurable clinical benefits in a real-world, multicenter population using a nationally representative database.

A retrospective cohort study was conducted using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database (2022-2023). Adult patients undergoing elective minimally invasive inguinal hernia repair were identified using CPT code 49650. Patients were stratified into robotic and laparoscopic cohorts. Primary outcomes included conversion to open surgery and operative time; secondary outcomes included 30-day complications, mortality, hospital length of stay, and readmission. Statistical analyses included univariate and multivariate logistic regression.

Of 34,257 cases analyzed, 54.9% were robotic and 45.1% laparoscopic. Robotic cases had significantly lower conversion to open rates (0.1% vs. 0.4%, p < 0.001) but longer operative times (82.5 vs. 65 min, p < 0.001). Perioperative complications, mortality, and readmission rates were comparable between groups. Multivariate analysis showed robotic surgery as an independent protective factor against conversion (OR 0.36, 95% CI: 0.22-0.57, p < 0.001).

Robotic-assisted inguinal hernia repair is associated with a lower conversion rate to open surgery without increased complications, despite longer operative times and a higher comorbidity burden. These findings support the selective use of robotics, particularly in complex cases, while highlighting the need for further cost-effectiveness and long-term outcomes research.