Multicenter review of robotic versus laparoscopic ventral hernia repair: is there a role for robotics?

Walker, Peter A.; May, Audriene; Mo, Jiandi; Cherla, Deepa V.; Santillan, Monica Rosales; Kim, Steven; Ryan, Heidi; Shah, Shinil K.; Wilson, Erik B.; Tsuda, Shawn

doi:10.1007/s00464-017-5882-5

Cited by 35 publications

(23 citation statements)

References 12 publications

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“…We selected 50 cases for our ramp-up period to ensure that operating room teams and surgeons had optimized workflow and to mitigate any risk of longer operative time and complications associated with a possible “learning curve” effect of the standardized ventral hernia repair technique used for this study. Patients in the “ramp-up” period were not included in this study; however, we reviewed and published our previous clinical experience with robotics to establish a baseline of expertise 1516…”

Section: Methodsmentioning

confidence: 99%

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Robotic versus laparoscopic ventral hernia repair: multicenter, blinded randomized controlled trial

Olavarria

Bernardi

Shah

et al. 2020

BMJ

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ObjectiveTo determine whether robotic ventral hernia repair is associated with fewer days in the hospital 90 days after surgery compared with laparoscopic repair.DesignPragmatic, blinded randomized controlled trial.SettingMultidisciplinary hernia clinics in Houston, USA.Participants124 patients, deemed appropriate candidates for elective minimally invasive ventral hernia repair, consecutively presenting from April 2018 to February 2019.InterventionsRobotic ventral hernia repair (n=65) versus laparoscopic ventral hernia repair (n=59).Main outcome measuresThe primary outcome was number of days in hospital within 90 days after surgery. Secondary outcomes included emergency department visits, operating room time, wound complications, hernia recurrence, reoperation, abdominal wall quality of life, and costs from the healthcare system perspective. Outcomes were pre-specified before data collection began and analyzed as intention to treat.ResultsPatients from both groups were similar at baseline. Ninety day follow-up was completed in 123 (99%) patients. No evidence was seen of a difference in days in hospital between the two groups (median 0 v 0 days; relative rate 0.90, 95% confidence interval 0.37 to 2.19; P=0.82). For secondary outcomes, no differences were noted in emergency department visits, wound complications, hernia recurrence, or reoperation. However, robotic repair had longer operative duration (141 v 77 min; mean difference 62.89, 45.75 to 80.01; P≤0.001) and increased healthcare costs ($15 865 (£12 746; €14 125) v $12 955; cost ratio 1.21, 1.07 to 1.38; adjusted absolute cost difference $2767, $910 to $4626; P=0.004). Among patients with robotic ventral hernia repair, two had an enterotomy compared none with laparoscopic repair. The median one month postoperative improvement in abdominal wall quality of life was 3 with robotic ventral hernia repair compared with 15 following laparoscopic repair.ConclusionThis study found no evidence of a difference in 90 day postoperative hospital days between robotic and laparoscopic ventral hernia repair. However, robotic repair increased operative duration and healthcare costs.Trial registrationClinicaltrials.gov NCT03490266.

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Section: Methodsmentioning

confidence: 99%

“…Patients in the “ramp-up” period were not included in this study; however, we reviewed and published our previous clinical experience with robotics to establish a baseline of expertise. 15 16 …”

Section: Methodsmentioning

confidence: 99%

Robotic versus laparoscopic ventral hernia repair: multicenter, blinded randomized controlled trial

Olavarria

Bernardi

Shah

et al. 2020

BMJ

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“…All observational studies were performed in the USA, except for two studies 27 , 35 from Austria and Australia. Ten studies 12–14 , 23 , 25 , 29 , 30 , 32 , 35 , 38 were multi-institutional, 11 22 , 24 , 26–28 , 31 , 33 , 34 , 37 , 39 , 40 were from a single institution, and one study 36 did not specify the number of centres. Propensity matching was performed in six studies 23 , 25 , 30 , 32 , 36 , 38 .…”

Section: Resultsmentioning

confidence: 99%

“…Ten studies 12–14 , 23 , 25 , 29 , 30 , 32 , 35 , 38 were multi-institutional, 11 22 , 24 , 26–28 , 31 , 33 , 34 , 37 , 39 , 40 were from a single institution, and one study 36 did not specify the number of centres. Propensity matching was performed in six studies 23 , 25 , 30 , 32 , 36 , 38 . The sample size varied from 26 to 46 799 patients.…”

Section: Resultsmentioning

confidence: 99%

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Clinical outcomes and cost of robotic ventral hernia repair: systematic review

Childers

Virgilio

et al. 2021

BJS Open

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Background Robotic ventral hernia repair (VHR) has seen rapid adoption, but with limited data assessing clinical outcome or cost. This systematic review compared robotic VHR with laparoscopic and open approaches. Methods This systematic review was undertaken in accordance with PRISMA guidelines. PubMed, MEDLINE, Embase, and Cochrane databases were searched for articles with terms relating to ‘robot-assisted’, ‘cost effectiveness’, and ‘ventral hernia’ or ‘incisional hernia’ from 1 January 2010 to 10 November 2020. Intraoperative and postoperative outcomes, pain, recurrence, and cost data were extracted for narrative analysis. Results Of 25 studies that met the inclusion criteria, three were RCTs and 22 observational studies. Robotic VHR was associated with a longer duration of operation than open and laparoscopic repairs, but with fewer transfusions, shorter hospital stay, and lower complication rates than open repair. Robotic VHR was more expensive than laparoscopic repair, but not significantly different from open surgery in terms of cost. There were no significant differences in rates of intraoperative complication, conversion to open surgery, surgical-site infection, readmission, mortality, pain, or recurrence between the three approaches. Conclusion Robotic VHR was associated with a longer duration of operation, fewer transfusions, a shorter hospital stay, and fewer complications compared with open surgery. Robotic VHR had higher costs and a longer operating time than laparoscopic repair. Randomized or matched data with standardized reporting, long-term outcomes, and cost-effectiveness analyses are still required to weigh the clinical benefits against the cost of robotic VHR.

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Greco¹,

Abbati²

2019

Abdominal Wall Surgery

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Multicenter review of robotic versus laparoscopic ventral hernia repair: is there a role for robotics?

Cited by 35 publications

References 12 publications

Robotic versus laparoscopic ventral hernia repair: multicenter, blinded randomized controlled trial

Robotic versus laparoscopic ventral hernia repair: multicenter, blinded randomized controlled trial

Clinical outcomes and cost of robotic ventral hernia repair: systematic review

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