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Meta-Analysis
. 2025 Feb 18;29(1):95.
doi: 10.1007/s10029-025-03274-2.

Systematic review and meta-analysis on robotic assisted ventral hernia repair: the ROVER review

Sara Capoccia Giovannini #  1 , Maaike Vierstraete #  2 , M Frascio  3 , G Camerini  3 , F Muysoms  4 , C Stabilini  3
Affiliations
Meta-Analysis

Systematic review and meta-analysis on robotic assisted ventral hernia repair: the ROVER review

Sara Capoccia Giovannini et al. Hernia. .

Abstract

Introduction: Robotic surgery for ventral hernia repair (VHR) is gaining attention for its potential advantages over laparoscopic and open techniques. This approach combines the advantages of minimally invasive surgery with the ability to perform technically challenging procedures, often required in open surgery but difficult with conventional laparoscopy. We aim to evaluate the efficacy and safety of robotic VHR compared to other surgical approaches, focusing on postoperative complications, operative time, and costs.

Material and methods: A systematic review with meta-analysis were conducted, including 67 studies from January 2010 to May 2023 on Robotic VHR compared with other techniques. Primary outcome was 30-days postoperative complications; SSI, SSO, seroma, mortality, recurrence, length of hospital stay, operative time and costs were analysed as secondary outcomes.

Results: Robotic surgery was associated with longer operative times compared to both laparoscopic (MD 64.67 min; p < 0.001) and open repairs (MD 69.69 min; p < 0.001). However, it resulted, compared to open surgery, in fewer SSIs (OR 0.62; p 0.05), mortality (OR 0.44; p 0.04) and shorter hospital stay (MD -3.77 days; p < 0.001). No differences were found in overall complications or length of stay between robotic and laparoscopic approaches but higher costs and longer operative times were reported in robotic VHR.

Conclusions: Based on the currently available low-quality evidence, robotic VHR appears to offer limited advantages compared to laparoscopic techniques. However, when compared to open approaches, robotic VHR may demonstrate reduced postoperative complications and shorter hospital stays even if an higher rate of seroma formation was retrieved probably related to technical details. Nevertheless, longer operative times and higher costs remain significant limitations. Further high-quality comparative studies are warranted to assess long-term outcomes and cost-effectiveness.

Keywords: Laparoscopy; Meta-analysis; Minimally invasive surgery; Robotic surgery; TAR; Ventral hernia repair.

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Conflict of interest statement

Declarations. Competing interest: SCG, MF, GC and MV have no COI to declare. CS is General Secretary elected of EHS,FM is president of Belgian Hernia society, Received grants from Medtronic, intuitive, BD and FEG textile, CMR surgical, Sofradim, GORE WL, EHS, EAES, AHS.

References

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    1. Muysoms F, Van Cleven S, Pletinckx P, Ballecer C, Ramaswamy A (2018) Robotic transabdominal retromuscular umbilical prosthetic hernia repair (TARUP): observational study on the operative time during the learning curve. Hernia 1101–1111. https://doi.org/10.1007/s10029-018-1825-x
    1. Baur J, Ramser M, Keller N, Muysoms F, Dorfer J, Wiegering A, Eisner L, A. Dietz U (2021) Robotic hernia repair: part II: robotic primary ventral and incisional hernia repair (rv-TAPP and r-Rives or r-TARUP). Video report and results of a series of 118 patients. Chirurg 809–821. https://doi.org/10.1007/s00104-021-01450-5
    1. Dewulf M, Dietz UA, Montgomery A, Pauli EM, Marturano MN, Ayuso SA, Augenstein VA, Lambrecht JR, Köhler G, Keller N, Wiegering A, Muysoms F (2022) Robotic hernia surgery IV. English version. Die Chirurgie 129–140. https://doi.org/10.1007/s00104-022-01779-5
    1. Henriksen NA, Helgstrand F, Jensen KK (2024) Short-term outcomes after open versus robot-assisted repair of ventral hernias: a nationwide database study. Hernia 233-240. https://doi.org/10.1007/s10029-023-02923-8

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