Robotic-Assisted Surgery With the Da Vinci Surgical System Compared to Laparoscopic or Open Ventral Hernia Repair: A Systematic Literature Review and Meta-Analysis

OBJECTIVES: This systematic literature review and meta-analysis assesses the clinical and patient value of robotic-assisted surgery (RAS) with da Vinci surgical systems compared to laparoscopic or open surgery for ventral hernia repair (VHR).

METHODS: A search of PubMed, Embase, and Scopus databases was conducted between January 1, 2010 and March 1, 2024 for studies comparing RAS with da Vinci surgical systems, laparoscopic, and open VHR. Publications were excluded for the following: not in English, pediatric cases, mixed procedures or study arms, no relevant outcomes, or redundant data. Outcomes assessed were operative time, conversions, hospital stay, postoperative complications, pain, reoperations, readmissions, hernia recurrence, quality of life, and short-term mortality.

RESULTS: We identified 38 relevant studies: 5 randomized controlled trials, 1 prospective, 13 large database, and 19 retrospective studies. Compared to laparoscopic surgery, patients undergoing RAS VHR were less likely to be converted to open surgery (OR=0.54[0.44,0.66], p<0.01), had fewer 30-day reoperations (OR=0.43[0.22,0.81], p<0.01), reported less pain at 30-day follow up (MD=-0.80[-1.40,-0.20] VAS score, p<0.01), and had less hernia recurrence at 2-years (OR=0.23[0.06,0.85], p=0.03). Compared to open surgery, patients undergoing RAS VHR had shorter length of stay (MD=2.57[-3.23,-1.91], p<0.01), fewer 30-day readmissions (OR=0.71[0.56, 0.90], p<0.01), fewer 30-day post-operative complications (OR=0.69[0.49, 0.96], p=0.03), less hernia recurrence at 30-days (OR=0.16[0.03,0.95], p=0.04), and a lower likelihood of 30-day mortality (p<0.01). Operative time was longer for RAS VHR compared to both laparoscopic and open approaches by 58 and 93 minutes, respectively. All other outcomes were comparable.

CONCLUSIONS: Our study demonstrate that using the da Vinci surgical system/s for VHR results in added benefits to the patient, including less pain and lower rates of hernia recurrence. Additional research is needed on patient recovery and quality of life.