From hands to handles: a modern duel between laparoscopic TEP and robotic TAPP

BACKGROUND: Robotic surgery has emerged as a modern alternative to conventional laparoscopic approaches for inguinal hernia repair. While the robotic transabdominal preperitoneal (TAPP, RTA group) technique offers improved dexterity and visualization, its clinical benefit over laparoscopic totally extraperitoneal (TEP, LTE group) repair remains under debate. METHODS: This retrospective study included 332 patients who underwent inguinal hernia surgery at a single institution between April 2021 and December 2023. After excluding cases of open hernia repair and laparoscopic TAPP, 191 patients underwent laparoscopic TEP (LTE group) and 67 underwent robotic TAPP (RTA group). Propensity score matching (1:1) was performed based on demographic and clinical variables, yielding 67 patients in each group for comparison. Operative time, intraoperative complications, and other surgical outcomes were analyzed. RESULTS: The RTA group showed significantly longer operative times compared to the LTE group for both unilateral and bilateral cases. However, intraoperative complications such as peritoneal tearing and bleeding were fewer in the RTA group, with no intraoperative conversions observed, and no postoperative return-to-OR events occurred. A temporal trend analysis also revealed a gradual decrease in operative time for RTA following the initial learning period. CONCLUSIONS: While robotic TAPP requires longer operative time, it demonstrated fewer intraoperative complications and stable postoperative outcomes. These findings suggest that robotic TAPP may be a feasible alternative in selected patients.