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Comparative studies for robotic versus open and/or laparoscopic inguinal hernia repair

Comparative studies for robotic versus open and/or laparoscopic inguinal hernia repair
Author
Year
COI Study design Study n Findings
Cost OR time Complications Pain, QOL
Holleran TJ et al,
2021[1]
No Retrospective, large database O, L, R

O 100,880

L 18,035

R 6063
  Longer for R, but improved over study period (2008-2019) Higher complication rate for R, but improved over study period (2008-2019)  
Tatarian et al,
2021[2]
Yes Retrospective, large database O, L, R

O 117,603

L 35,565

R 559

   

Unadjusted analysis: higher complication and recurrence rate at 5 years for R compared with O and L

Propensity score analysis: no difference in outcomes or recurrences at 5 years
 
Zhao F et al,
2021[3]
No Systematic review, meta-analysis L, R

L 661

R 459
  Longer for R Similar LOS and complication rate for L and R Similar for L and R
LeBlanc K et al,
2020[4]
Yes Multicenter, prospective, nonrandomized, propensity matched L: 19% TAPP; 81% TEP, R, O L versus R: 80 each; L versus O: 112 each   R longer than O (74.0 versus 51.5 min); R longer than L (83.0 versus 65.0 min) No difference Greater need for pain medications in O versus R and L versus R; time to return to normal activities 3 days for R versus 4 days for O; no difference in time to return to normal activities for L versus R; higher QOL R versus O, no difference QOL L versus R
Prabhu AS et al,
2020[5]
Yes Multicenter, randomized L-TAPP, R

L 54

R 48
R higher ($3258 versus $1421, p<0.001) R longer (75.5 versus 41.5 min, p<0.001) No difference in wound events or readmissions No difference
Sheldon RR et al,
2019[6]
No Retrospective O, L-TEP

R 49

O 9

L 34
      No difference in postoperative repeat opiate Rx
Abdelmoaty WF et al,
2018[7]
Yes Retrospective cost-analysis L

R 734

L 1671
R higher average cost, lower average variable cost R longer OR time No difference in LOS, conversion to open  
Bittner JG et al,
2018[8]

Yes

Robotic company employees
Prospective propensity for treatment matched O, L

R 83 to 85

O 85

L 83
      Longer time from IHR to no Rx pain meds with O compared to L, R (p = 0.03); higher groin pain scores at 1 week with O compared to L, R (p<0.01); more activity disruption at 1 week with O compared to L, R (p<0.01)
Charles EJ et al,
2018[9]
Yes Retrospective, NSQIP database O, L

R 69

L 241

O 191
    No difference in postoperative occurrences, adverse events, readmissions  
Gamagami R et al,
2018[10]
Yes Retrospective, multicenter O

R 652

O 602
  Longer skin-to-skin times for R (p<0.0001) No difference in 30 day complications, readmissions, reoperations  
Kolachalam R et al,
2018[11]
Yes Retrospective propensity for treatment-matched O

R 95 matched, 148 unadjusted

O 93 matched, 113 unadjusted
  Longer OR times for R (p<0.0001 unadjusted, p<0.001 matched) Increased post-discharge complications to 30 days for O (p = 0.005 unadjusted, p = 0.047 matched)  
Kosturakis AK et al,
2018[12]
No Retrospective case-matched O

R 100

O 100
  No difference in OR times   More multiple postoperative visits for pain for O IHR (p = 0.003)
Muysoms F et al,
2018[13]
Yes Observational case control L-TAPP

R 49

L 64
  No difference in OR time after learning curve No difference in complications  
Kudsi OY et al,
2017[14]
Yes Retrospective single surgeon L-TEP

R 118

L 157
  No difference No difference in 30 day complications  
Waite KE et al,
2016[15]
No Retrospective L-TAPP

R 39

L 24
Cost per case was similar L and R when results separated into unilateral versus bilateral Longer OR time for R (p<0.001 for unilateral, p = 0.004 for bilateral)   Recovery time, average pain were similar L and R when results separated into unilateral versus bilateral
COI: conflicts of interest; OR: operating room; QOL: quality of life; O: open; L: laparoscopic; R: robotic; LOS: length of stay; TAPP: transabdominal preperitoneal; TEP: totally extraperitoneal; L-TAPP: laparoscopic transabdominal preperitoneal; L-TEP: laparoscopic totally extraperitoneal; IHR: inguinal hernia repair; NSQIP: National Surgical Quality Improvement Program.
References:
  1. Holleran TJ, Napolitano MA, Sparks AD, et al. Trends and outcomes of open, laparoscopic, and robotic inguinal hernia repair in the veterans affairs system. Hernia 2021.
  2. Tatarian T, Nie L, McPartland C, et al. Comparative perioperative and 5-year outcomes of robotic and laparoscopic or open inguinal hernia repair: A study of 153,727 patients in the state of New York. Surg Endosc 2021.
  3. Zhao F, Wang B, Chen J. Comparison between robotic and laparoscopic inguinal hernia repair in Caucasian patients: A systematic review and meta-analysis. Ann Transl Med 2021; 9:885.
  4. LeBlanc K, Dickens E, Gonzalez A, et l. Prospective, multicenter, pairwise analysis of robotic-assisted inguinal hernia repair with open and laparoscopic inguinal hernia repair: Early results from the Prospective Hernia Study. Hernia 2020; 24:1069.
  5. Prabhu AS, Carbonell A, Hope W, et al. Robotic inguinal vs transabdominal laparoscopic inguinal hernia repair: The RIVAL randomized clinical trial. JAMA Surg 2020; 155:380.
  6. Sheldon RR, Do WS, Weiss JB, et al. Sage wisdom or anecdotal dictum? Equivalent opioid use after open, laparoscopic, and robotic inguinal hernia repair. Am J Surg 2019.
  7. Abdelmoaty WF, Dunst CM, Neighorn C, et al. Robotic-assisted versus laparoscopic unilateral inguinal hernia repair: A comprehensive cost analysis. Surg Endosc 2018.
  8. Bittner Iv JG, Cesnik LW, Kirwan T, et al. Patient perceptions of acute pain and activity disruption following inguinal hernia repair: a propensity-matched comparison of robotic-assisted, laparoscopic, and open approaches. J Robot Surg 2018; 12:625.
  9. Charles EJ, Mehaffey JH, Tache-Leon CA, et al. Inguinal hernia repair: Is there a benefit to using the robot? Surg Endosc 2018; 32:2131.
  10. Gamagami R, Dickens E, Gonzalez A, et al. Open versus robotic-assisted transabdominal preperitoneal (R-TAPP) inguinal hernia repair: A multicenter matched analysis of clinical outcomes. Hernia 2018; 22:827.
  11. Kolachalam R, Dickens E, D'Amico L, et al. Early outcomes of robotic-assisted inguinal hernia repair in obese patients: A multi-institutional, retrospective study. Surg Endosc 2018; 32:229.
  12. Kosturakis AK, LaRusso KE, Carroll ND, Nicholl MB. First 100 consecutive robotic inguinal hernia repairs at a Veterans Affairs hospital. J Robot Surg 2018; 12:699.
  13. Muysoms F, Van Cleven S, Kyle-Leinhase I, et al. Robotic-assisted laparoscopic groin hernia repair: Observational case-control study on the operative time during the learning curve. Surg Endosc 2018; 32:4850.
  14. Kudsi OY, McCarty JC, Paluvoi N, Mabardy AS. Transition from laparoscopic totally extraperitoneal inguinal hernia repair to robotic transabdominal preperitoneal inguinal hernia repair: A retrospective review of a single surgeon's experience. World J Surg 2017; 41:2251.
  15. Waite KE, Herman MA, Doyle PJ. Comparison of robotic versus laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair. J Robot Surg 2016; 10:239.
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