Presentation (CTI)

OBJECTIVES: This review and meta-analysis compare perioperative outcomes for benign robotic-assisted surgery(RAS) using da Vinci surgical systems, laparoscopic-assisted(Lap), and open inguinal hernia repair(IHR).
METHODS: A PRISMA-guided literature review and meta-analysis compared RAS with Lap and open approaches in patients undergoing primary IHR. The 14-year search on PubMed, Embase, and Scopus included English studies, excluding pediatric cases, malignancies, irrelevant outcomes, and redundant data. We evaluated operative time, conversions, transfusions, blood loss(EBL), hospital stay(LOS), surgical site infections(SSI), 30-day complications, readmissions, reoperations, mortality, recurrence rates and quality-of-life outcomes such as pain and pain scores.
RESULTS: The search identified 40 publications relevant for the meta-analysis. Compared to Lap, RAS had a 53% lower chance of conversion to open surgery(OR:0.47[0.22;0.99],p=0.05), significantly lower VAS pain scores during hospitalization(WMD:-1.02[-1.85;-0.19],p=0.02), a 49% lower chance of hernia recurrence within 1-year of surgery(OR:0.51[0.31;0.85],p<0.01) and a 51% reduced likelihood of hernia recurrence ≥2-years post-surgery(OR:0.49[0.29;0.86],p=0.01). Operative time was longer with RAS for unilateral IHR(WMD:19.08[10.84;27.31],p<0.01) and bilateral IHR(WMD:21.42[2.14;40.69],p=0.03). There was no difference in EBL, transfusions, SSI, LOS, 30-day postoperative complications, readmissions, reoperations, recurrence and mortality rate. Quality-of-life 30-days, 1-year and 2-year pain outcomes were similar between RAS and Lap IHRs. Compared to open surgery, RAS showed a 68% lower likelihood of 30-day acute pain(OR:0.32[0.16;0.67],p<0.01) and significantly lower VAS pain scores by an average of 2 points(WMD:-2.00[-3.99;-0.01],p=0.05). Operative time for RAS was significantly longer, (WMD:22.96[9.14;36.78],p<0.01) for unilateral and (WMD:26.69[10.04;43.34],p<0.01) for bilateral hernia repairs. Blood transfusion rate, SSI, hospital LOS, 30-day outcomes (complications, reoperations, readmissions, recurrence, mortality rates), 1-year and ≥2-year hernia recurrence rates were similar between RAS and open surgery.
CONCLUSIONS: The da Vinci system is a safe and effective choice for IHR with better recurrence rates at 1 and 2 years follow up compared to Lap repair. Further research is necessary on pain and quality of life outcomes, potentially through additional database studies.