Robotic ventral hernia repair versus non-robotic techniques: a SAGES systematic review and meta-analysis

Robotic surgery is common in ventral hernia repairs (VHR). A systematic review and meta-analysis were undertaken to evaluate robotic approaches.

Analysis was performed to compare: (1) robotic intraperitoneal underlay mesh (rIPUM) versus laparoscopic IPUM; (2) robotic extended totally extraperitoneal (eTEP) retrorectus versus open retrorectus; (3) robotic transabdominal preperitoneal (rTAPP) versus IPUM; (4) robotic transversus abdominis release (rTAR) versus open TAR.

rIPUM had decreased odds of overall complications (OR 0.59, 95% CI 0.09-3.78) versus laparoscopic IPUM, which had shorter operative times (mean difference 63.54 min, 95% CI 50.81-76.28). Robotic retrorectus had a shorter mean length of stay (1.0 day mean decrease, 95% CI -1.57 to -0.43), while open retrorectus had a shorter mean operative time (44.70 min mean decrease, 95% CI -63.33 to -26.07); robotic retrorectus also showed a trend toward higher overall complications (OR 2.69, 95% CI 0.99-7.32), with no significant differences in SSI, SSO, reoperation, or quality of life. rTAPP had decreased odds of overall complication (OR 0.54, 95% CI 0.33-0.90), readmission (OR 0.20, 95% CI 0.06-0.65), surgical site infection (OR 0.28, 95% CI 0.08-0.94), and shorter operative times (mean difference -15.28 min, 95% CI -22.54 to -8.01) versus IPUM. rTAR had decreased odds of overall complications (OR 0.23, 95% 0.11-0.51), Clavien-Dindo grade 2 or greater complications (OR 0.14, 95% CI 0.02-0.91), shorter mean length of stay (LOS, 4.37 day mean decrease, 95% CI -5.79 to -2.95), lower mean estimated blood loss (90.00 ml mean decrease, 95% CI -128.55 to -51.45), and longer mean operative time (82.24 min mean increase, 95% CI 58.89-105.59) versus open TAR.

Differences in these VHR techniques should be interpreted cautiously given literature limited to mostly studies demonstrating high risk of bias with few comparative studies. Several robotic techniques appear to have lower morbidity rates and LOS while demonstrating longer operative times. Further research is necessary to address the paucity of high-quality comparative studies.