Robotic Transabdominal Preperitoneal Repair Versus Laparoscopic Totally Extraperitoneal Repair for Inguinal Hernia

To date, no Japanese studies have compared robotic transabdominal preperitoneal repair (R-TAPP) and laparoscopic totally extraperitoneal repair (L-TEP). Herein, we present our initial experience from a single Japanese hospital, comparing both procedures and evaluating their short-term outcomes in the context of potential inclusion under Japan's national health insurance system.

Patients with inguinal hernias who had not undergone previous anterior hernioplasty were retrospectively analyzed. Demographic factors (age, sex, body mass index) and perioperative data were collected. Surgical variables and postoperative outcomes were compared between patients who underwent R-TAPP using the da Vinci ξ robotic platform (Intuitive Surgical, Sunnyvale, CA) and those who underwent L-TEP. Data were assessed for all, unilateral, and bilateral cases. Five surgeons participated in this study. Surgeon-specific variables, including the number of R-TAPP and L-TEP procedures performed by each surgeons, operative times, and complication rates, were also collected to evaluate the influence of the surgeon's experience on perioperative outcomes.

Resident participation significantly differed between the 2 techniques across total, unilateral, and bilateral groups. In the unilateral subgroup, the mean operative time was shorter for R-TAPP (95.4 minutes) than for L-TEP (122.3 minutes). The R-TAPP group had higher costs, but complication rates were comparable. One Clavien-Dindo grade III postoperative bleeding event occurred in the L-TEP group, while only minor complications, including paralytic ileus and inferior epigastric artery injury, were observed after R-TAPP. The surgeon-specific analysis demonstrated variability in operative times among the 5 surgeons; however, 4 of the 5 surgeons showed consistently shorter operative times with R-TAPP than with L-TEP, suggesting a procedural trend favoring R-TAPP despite differences in experience.

Both R-TAPP and L-TEP were performed safely, with no notable differences in perioperative outcomes. However, R-TAPP may provide improved operative efficiency, particularly in primary unilateral inguinal hernias. Although surgeon experience influenced operative performance, the consistent trend toward shorter operative times across surgeons suggests that R-TAPP may offer intrinsic procedural advantages. Further prospective studies with balanced surgeon distribution and long-term follow-up are warranted.