Bilateral Inguinal Hernia Repair: Robotic TAPP Versus Laparoscopic TEP

Gündoğdu, Emre; Güldoğan, Cem Emir; Özmen, Mehmet Mahir

doi:10.1097/sle.0000000000000890

Cited by 10 publications

(3 citation statements)

References 23 publications

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“…However, only a few studies comparing the laparoscopic and the robotic approach have been published [ 4 – 16 ]. The majority of them were characterized by small sample size, especially in the robotic arm, [ 6 , 7 , 9 , 16 , 17 ], limiting the power and, thus, the generalizability, of the studies.…”

Section: Introductionmentioning

confidence: 99%

Robotic versus laparoscopic inguinal hernia repair: an updated systematic review and meta-analysis

et al. 2021

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The aim of this study was to review the latest evidence on the robotic approach (RHR) for inguinal hernia repair comparing the pooled outcome of this technique with those of the standard laparoscopic procedure (LHR). A systematic literature search was performed in PubMed, Web of Science and Scopus for studies published between 2010 and 2021 concerning the comparison between RHR versus LHR. After screening 582 articles, 9 articles with a total of 64,426 patients (7589 RHRs) were eligible for inclusion. Among preoperative variables, a pooled higher ratio of ASA > 2 patients was found in the robotic group (12.4 vs 8.6%, p < 0.001). Unilateral hernia repair was more common in the laparoscopic group (79.9 vs 68.1, p < 0.001). Overall, operative time was longer in the robotic group (160 vs 90 min, p < 0.001); this was confirmed also in the sub-analysis on unilateral procedures (88 vs 68 min, p = 0.040). The operative time for robotic bilateral repair was similar to the laparoscopic one (111 vs 100, p = 0.797). Conversion to open surgery was 0% in the robotic group. The pooled rate of chronic pain and postoperative complications was similar between the groups. The standardized mean difference MD of the costs between LHR versus RHR was − 3270$ (95% CI – 4757 to − 1782, p < 0.001). In conclusion, laparoscopic and robotic inguinal hernia repair have similar safety parameters and postoperative outcomes. Robotic approach may require longer operative time if the unilateral repair is performed. Costs are higher in the robotic group.

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Section: Introductionmentioning

confidence: 99%

Robotic versus laparoscopic inguinal hernia repair: an updated systematic review and meta-analysis

et al. 2021

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“…As the US population ages, it will be increasingly important to identify best practices when it comes to surgical care for older adults. Studies have shown that robotic ventral hernia repairs can provide clinical benefits, such as lower rates of wound complications 15,16 and shorter length of stays 10,16 compared to open approaches. However, there is no data examining the role of robotic surgery in retromuscular hernia repair specifically in older patients.…”

Section: Discussionmentioning

confidence: 99%

Robotic vs. Open Approach for Older Adults Undergoing Retromuscular Ventral Hernia Repair

Collins

Renshaw

Huang³

et al. 2021

Annals of Surgery

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Objective: To describe 30-day outcomes including post-operative complications, readmissions, and quality of life score changes for older adults undergoing elective ventral hernia repair with retromuscular mesh placement and to compare rates of these outcomes for individuals undergoing robotic versus open approaches. Summary of Background Data: Over one third of patients presenting for elective ventral hernia repair are over the age of 65 and many have complex surgical histories that warrant intricate hernia repairs. Robotic ventral hernia repairs have gained increasing popularity in the US and in some studies have demonstrated decreased rates of postoperative complications, and less pain resulting in shorter hospital stays. However, the robotic approach has several downsides including prolonged operative times as well as the use of pneumo-peritoneum which may be risky in older patients. Methods: We performed a retrospective review of prospectively collected data in a national hernia specific registry (the Abdominal Core Health Quality Collaborative) and identified patients over the age of 65 undergoing either an open or robotic retromuscular ventral hernia repair. After propensity score matching adjusting for demographic, clinical, and hernia related factors, logistic regression was used to compare 30-day complications, readmission, and quality of life (QoL) scores as captured by the HerQLes scale for patients undergoing each approach. Results: Of 2128 patients who met inclusion criteria, 1695 (79.7%) underwent open ventral hernia repair while 433 (20.3%) underwent robotic repair. After propensity score matching, there were 350 robotic cases and 759 open cases for analysis. Patients undergoing robotic repairs demonstrated significantly shorter length of stays (1 vs 4 days, P < 0.01) and had equivalent odds of both 30-day post-operative complications (odds ratio [OR] 1.15 95% confidence interval 0.92–1.44) and readmission (OR 1.09 95% confidence interval 0.74–1.6) compared to the open approach. QoL scores were similar between groups at 30 days but were slightly better for robotic patients at 1 year (92 vs 84 P < 0.01). Conclusions: Robotic ventral hernia repair is an option for appropriately selected older patients undergoing retromuscular ventral hernia repair, demonstrating shorter hospital stays and equivalent rates of complications and readmissions in the post-operative period. However, more data is needed regarding QoL outcomes and long-term function, especially as it relates to recurrence rates, between the two approaches.

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“…In the literature, comparison of rTAPP and TEP shows controversial results. Some studies report lower pain scores and a lower incidence of complications for rTAPP compared to TEP [ 12 13 ]. Others show comparable results regarding postoperative outcomes such as pain, surgical site infection, hospital length of stay and recurrence rate [ 14 15 ].…”

Section: Introductionmentioning

confidence: 99%

Robotic Versus Conventional Minimal-Invasive Inguinal Hernia Repair: Study Protocol for a Prospective, Randomized and Blinded Clinical Trial

Angehrn

Neuschütz

Baur

et al. 2022

International Journal of Surgery Protocols

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Introduction: Inguinal hernia repairs are commonly performed procedures. The surgical techniques vary from open procedures to minimally invasive and robotic-assisted surgeries and include totally extra-peritoneal hernia repairs (TEP) and robotic transabdominal pre-peritoneal hernia repairs (rTAPP). So far, there is no randomized and blinded clinical trial comparing these two surgical approaches. Our objective is to investigate whether rTAPP is associated with a decreased postoperative level of pain. Methods: This is a prospective, single center, randomized and blinded clinical trial. Patients will receive either rTAPP or TEP for uni- or bilateral inguinal hernias. All patients and assessors of the study are blinded to the randomization. The perioperative setting is standardized, and all surgeons will perform both rTAPP and TEP to eliminate surgeons` bias. Primary endpoint is the assessment of pain while coughing 24 hours after surgery using the numeric rating scale (NRS). Secondary endpoints include the assessment of multiple pain and quality of life questionnaires at several defined times according to the study schedule. Furthermore, intra- and postoperative complications, duration until discharge, procedure time, duration of postoperative sick leave and the recurrence rate will be evaluated. Registry: The trial has been registered at ClinicalTrials.gov under the registry number NCT05216276. Highlights Trial comparing robotic and conventional minimal-invasive inguinal hernia repair Randomized and patient/assessor blinded trial Early postoperative pain as primary outcome (24 hours) Secondary patient outcomes include pain and quality of life scores up to one year Further secondary outcomes: complications, costs, surgeon’s stress level

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Bilateral Inguinal Hernia Repair: Robotic TAPP Versus Laparoscopic TEP

Abstract: The authors state that this study has been approved by the appropriate institutional and research ethics committee and has been performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Cited by 10 publications

References 23 publications

Robotic versus laparoscopic inguinal hernia repair: an updated systematic review and meta-analysis

Robotic versus laparoscopic inguinal hernia repair: an updated systematic review and meta-analysis

Robotic vs. Open Approach for Older Adults Undergoing Retromuscular Ventral Hernia Repair

Robotic Versus Conventional Minimal-Invasive Inguinal Hernia Repair: Study Protocol for a Prospective, Randomized and Blinded Clinical Trial

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