OBJECTIVES: To examine the trends and outcomes of knotless tissue control devices (KTCD) (Ethicon, Inc.) vs. smooth sutures for wound closure in robotic ventral hernia repair.

METHODS: Retrospective analysis of hospital data from the US Premier Healthcare Database. Study subjects were age ≥18 years and had a robotic surgical admission for ventral hernia repair (VHR) between 10/01/2015-06/30/2022 (first admission=index). Quarterly KTCD utilization trends were measured descriptively. Outcomes measured during the surgical admission included: operating room (OR) time, in-hospital through 90-day post-discharge wound-related complications, and total hospital costs. We used 1:1 propensity score matching to balance the KTCD and smooth suture groups on numerous patient and hospital/provider characteristics. Generalized estimating equations, accounting for hospital-level clustering, with link functions and error distributions tailored to the empirical distribution of post-match outcomes, were used to test for statistically significant differences between the KTCD and smooth sutures groups.

RESULTS: From Q4 2015 to Q2 2022, KTCD utilization more than doubled in robotic VHR (from 12.2% to 25.3%). Among 32,469 identified patients, after matching, 6,687 patients remained in each group (13,374 total); median age 57 years, 53.1% female. The observed OR time was lower in the KTCD group as compared with the smooth sutures group (154.3 minutes-KTCD vs. 172.7 minutes-smooth sutures, difference=18.4 minutes [95% CI -32.7 to -4.0], P=0.012). The observed incidence proportion of wound-related complications was similar between the groups (0.91%-KTCD vs. 0.91%- smooth sutures, difference=0.0% [95% CI -0.34% to 0.34%], P=1.000). Total hospital costs were also similar between the groups ($10,719-KTCD vs. $10,720- smooth sutures, difference=$1 [95% CI -$1,114 to $1,112], P=0.999).

CONCLUSIONS: In this retrospective study of patients undergoing robotic VHR, adoption of KTCD grew substantially over the past 6 years. While most clinical and economic outcomes were similar between the two groups, KTCD was associated with significantly lower operating room time vs. smooth sutures.