Laparoscopic versus robotic transabdominal preperitoneal inguinal hernia repair: a randomized controlled trial

Robotic inguinal hernia repair (RIHR) has emerged as an alternative to laparoscopic transabdominal preperitoneal (TAPP) repair, offering improved ergonomics and dexterity. However, evidence comparing early outcomes between the two approaches, particularly in the Indian population, remains limited.

A single-center, parallel arm, participant- and assessor-blinded randomized controlled trial was conducted between January 2022 and June 2023 after institutional ethics approval (AIIMS/IEC/2022/3928) and trial registration (CTRI/2022/07/043873). A total of 101 adult patients with uncomplicated inguinal hernia were randomized (2:1) to laparoscopic TAPP (n = 67) or robotic TAPP (n = 34). The primary outcome was postoperative pain assessed using the Visual Analog Scale (VAS) at 3, 6, and 12 h. Secondary outcomes included operative time, peritoneal flap dissection time, time to resume normal activities, and postoperative complications up to 4 weeks.

Baseline characteristics were well balanced between the groups. No significant differences were observed in postoperative pain scores at 3, 6, and 12 h, with mean differences (robotic minus laparoscopic) of 0.28 (95% CI, - 0.34 to 0.90; p = 0.261), - 0.16 (95% CI, - 0.69 to 0.37; p = 0.733), and 0.32 (95% CI, - 0.15 to 0.79; p = 0.307), respectively. The requirement for rescue analgesia was similar between the groups (20.6% vs. 17.9%; absolute risk difference, 2.7%; 95% CI, -13.7% to 19.1%; p = 0.744). Total operative time and time to resumption of normal daily activities did not differ significantly between the groups (p = 0.142 and p = 0.180, respectively). Postoperative complication rates, including pain, seroma, and surgical site infection, were not significantly different between the groups at both the 1-week and 4-week follow-up.

Robotic TAPP was not superior to laparoscopic TAPP for early postoperative pain, operative duration, return to normal activities, or short-term complications. Given the similar clinical outcomes and higher resource demands, the routine adoption of robotic TAPP in low-resource settings remains debatable. Larger, multicentre studies with longer follow-up are warranted.