Comparative outcomes of robotic versus laparoscopic inguinal hernia repair: a systematic review and meta-analysis

To compare clinical, operative, patient-reported, and economic outcomes of robotic versus laparoscopic inguinal hernia repair in adults. We conducted a PRISMA 2020-compliant systematic review and meta-analysis of PubMed, Web of Science, and Google Scholar through June 13, 2025. The protocol was retrospectively registered in PROSPERO (CRD420251075296). Comparative randomized and observational studies of elective robotic versus laparoscopic inguinal hernia repair in adults were eligible. Random-effects meta-analyses used restricted maximum-likelihood estimation with Hartung-Knapp confidence intervals; risk of bias was assessed using RoB 2 and MINORS, and certainty was evaluated using GRADE. Nineteen reports representing 18 unique cohorts and 78,940 participants were included. Nine reports (3,200 participants) contributed recurrence data; robotic repair was associated with a lower observed recurrence risk (RR 0.32, 95% CI 0.17-0.59; I² = 0%), although certainty was low and the randomized evidence was imprecise. Robotic repair required longer operative time (11 studies; MD + 30.04 min, 95% CI 9.87-50.20; I² = 99.6%); after excluding the influential Holleran 2022 cohort, the estimate was + 22.09 min (95% CI 8.87-35.30). Pooled immediate and postoperative-day-1 pain estimates did not show a statistically significant difference. Length of stay was not significantly different in the primary analysis (MD + 0.33 days, 95% CI -0.03 to 0.70), while an influence analysis suggested a small increase after robotic repair (+ 0.18 days). Overall complication estimates were unstable, and no clear differences were found for hematoma, surgical-site infection, or urinary retention. Robotic repair was consistently more expensive across heterogeneous healthcare settings. Robotic inguinal hernia repair was associated with lower observed recurrence in predominantly non-randomized evidence, but this finding should not be interpreted as proof of causal superiority. Robotic repair generally required approximately 22-30 additional operative minutes and incurred higher costs, while pooled pain, length-of-stay, and complication findings were uncertain or clinically small. Technique selection should therefore consider patient and hernia characteristics, surgeon experience, institutional resources, and the low to very low certainty of the available evidence.