Inguinal hernia repair: is there a benefit to using the robot?

Abstract

Background: The number of robotic surgical procedures performed yearly is constantly rising, due to improved dexterity and visualization capabilities compared with conventional methods. We hypothesized that outcomes after robotic-assisted inguinal hernia repair would not be significantly different from outcomes after laparoscopic or open repair.

Methods: All patients undergoing inguinal hernia repair between 2012 and 2016 were identified using institutional American College of Surgeons National Surgical Quality Improvement Program data. Demographics; preoperative, intraoperative, and postoperative characteristics; and outcomes were evaluated based on method of repair (Robot, Lap, or Open). Categorical variables were analyzed by Chi-square test and continuous variables using Mann-Whitney U.

Results: A total of 510 patients were identified who underwent unilateral inguinal hernia repair (Robot: 13.8% [n = 69], Lap: 48.1% [n = 241], Open: 38.1% [n = 191]). There were no demographic differences between groups other than age (Robot: 52 [39-62], Lap: 57 [45-67], and Open: 56 [48-67] years, p = 0.03). Operative duration was also different (Robot: 105 [76-146] vs. Lap: 81 [61-103] vs. Open: 71 [56-88] min, p < 0.001). There were no operative mortalities and all patients except one were discharged home the same day. Postoperative occurrences (adverse events, readmissions, and death) were similar between groups (Robot: 2.9% [2], Lap: 3.3% [8], Open: 5.2% [10], p = 0.53). Although rare, there was a significant difference in rate of postoperative skin and soft tissue infection (Robot: 2.9% [2] vs. Lap: 0% [0] vs. Open: 0.5% [1], p = 0.02). Cost was significantly different between groups (Robot: $7162 [$5942-8375] vs. Lap: $4527 [$2310-6003] vs. Open: $4264 [$3277-5143], p < 0.001).

Conclusions: Outcomes after robotic-assisted inguinal hernia repair were similar to outcomes after laparoscopic or open repair. Longer operative duration during robotic repair may contribute to higher rates of skin and soft tissue infection. Higher cost should be considered, along with surgeon comfort level and patient preference when deciding whether inguinal hernia repair is approached robotically.

Keywords: Inguinal hernia repair; Laparoscopic inguinal hernia repair; Open inguinal hernia repair; Robotics.

Fig. 1

Total time in the operating room for robotic, laparoscopic, and open inguinal hernia repairs (Robot: 105 [76–146] vs. Lap: 81 [61–103] vs. Open: 71 [56–88] min, p < 0.001). Median [interquartile range], all such values

Fig. 2

A Physician charges per case for robotic, laparoscopic, and open inguinal hernia repairs. (Robot: $2663 [$1350–3376] vs. Lap: $2239 [$2046–2824] vs. Open: $2186 [$1852–2871], p = 0.82). B Total hospital charges per case for robotic, laparoscopic, and open inguinal hernia repairs (Robot: $27,017 [$20,993–34,443] vs. Lap: $16,016 [$11,444–21,761] vs. Open: $14,190 [$11,305–16,889], p < 0.001). C Hospital cost per case for robotic, laparoscopic, and open inguinal hernia repairs (Robot: $7162 [$5942–8375] vs. Lap: $4527 [$2310–6003] vs. Open: $4264 [$3277–5143], p < 0.001). Median [interquartile range], all such values