Robotic-assisted versus laparoscopic unilateral inguinal hernia repair: a comprehensive cost analysis

Abdelmoaty, Walaa; Dunst, Christy M.; Neighorn, Chris; Swanstrom, Lee L.; Hammill, Chet W.

doi:10.1007/s00464-018-06606-9

Cited by 58 publications

(40 citation statements)

References 34 publications

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“…Direct inguinal and femoral hernias reappear as recurrent hernias, especially in female patients, who intrinsically have a wide pelvic space[ 17 ]. Surgical repairs at the PPS that fully covers not only the entire MO but also the obturator foramen should be chosen, especially for female patients[ 17 ], even though easy hernioplasty with a mesh plug and onlay patch works well in elderly men[ 106 ]. TAPP repair is advantageous as it covers both the MO and obturator foramen.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, singleport robotic surgery (Single Port Robotic Surgical System, da Vinci Sp; Intuitive Surgical, Inc., Sunnyvale, CA, United States) is currently available. The direct cost and contribution margin are nearly equivalent between robotic and laparoscopic surgery[ 105 ], although robotic surgery had the higher cost for unilateral groin hernia[ 106 ].…”

Section: Cost-effectivenessmentioning

confidence: 99%

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Crucial anatomy and technical cues for laparoscopic transabdominal preperitoneal repair: Advanced manipulation for groin hernias in adults

Yasukawa

Aisu

Hori

2020

WJGS

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Groin hernias include indirect inguinal, direct inguinal, and femoral hernias. Obturator and supravesical hernias appear very close to the groin. High-quality repairs are required for groin hernias. The concept of “tension-free repair” is generally accepted, and surgical repairs with mesh are categorized as “hernioplasties”. Surgeons should have good knowledge of the relevant anatomy. Physicians generally focus on the preperitoneal space, myopectineal orifice, topographic nerves, and regional vessels. Currently, laparoscopic surgery has therapeutic potential in the surgical setting for hernioplasty, with laparoscopic transabdominal preperitoneal (TAPP) repair appearing to be a powerful tool for use in adult hernia patients. TAPP offers the advantages of accurate diagnoses, repair of bilateral and recurrent hernias, less postoperative pain, early recovery allowing work and activities, tension-free repair of the preperitoneal (posterior) space, ability to cover obturator hernias, and avoidance of potential injury to the spermatic cord. The disadvantages of TAPP are the need for general anesthesia, adhering to a learning curve, higher cost, unexpected complications related to abdominal organs, adhesion to the mesh, unexpected injuries to vessels, prolonged operative time, and as-yet-unknown long-term outcomes. Both technical skill and anatomical familiarity are important for safe, reliable surgery. With increasing awareness of the importance of anatomy during TAPP repair, we address the skills and pitfalls during laparoscopic TAPP repair in adult patients using illustrations and schemas. We also address debatable points on this subject.

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Section: Discussionmentioning

confidence: 99%

Section: Cost-effectivenessmentioning

confidence: 99%

Crucial anatomy and technical cues for laparoscopic transabdominal preperitoneal repair: Advanced manipulation for groin hernias in adults

Yasukawa

Aisu

Hori

2020

WJGS

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“…A previous multi-institutional study showed a longer intra-operative (125 vs. 90 min), operative (87 vs. 56 min), and PACU (70 vs. 59 min) time in the RIHR group. 7 However, length of stay seemed to be similar between RIHR and LIHR in primary and recurrent repairs; ranging from 0.24 to 0.26 days. Another study, in a dedicated minimally-invasive surgery center, showed an increased mean operative time in RIHR compared to LIHR (116 vs. 95 min, p < 0.01); with a significantly longer operative time in unilateral IHR (110 vs. 88 min, p < 0.01) and a trend toward longer operative time in bilateral IHR (143 vs. 114 min, p = 0.06) in the robotic group.…”

Section: Discussionmentioning

confidence: 90%

“… 5 , 6 Such advantages to RIHR are offset by the prolonged intra-operative time and higher cost compared to the laparoscopic approach. 7 , 8 …”

Section: Introductionmentioning

confidence: 99%

“…Most previous studies compare RIHR to laparoscopic and open IHR, showing increased operative time and cost in the robotic technique. 7 , 13 However, the previous studies of robotic abdomino-pelvic surgery have smaller sample size and do not seem to examine such outcomes across the learning curve. The aim of this study is to compare intra-operative time, direct operative cost, and postoperative complication rate between an early and a late phase of RIHR learning curve of multiple surgeons.…”

Section: Introductionmentioning

confidence: 99%

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Robotic Inguinal Hernia Repair Outcomes: Operative Time and Cost Analysis

Awad

Buzalewski

Anderson

et al. 2020

JSLS

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Background: Robotic inguinal hernia repair is the latest iteration of minimally invasive herniorrhaphy. Previous studies have shown expedited learning curves compared to traditional laparoscopy, which may be offset by higher cost and longer operative time. We sought to compare operative time and direct cost across the evolving surgical practice of 10 surgeons in our healthcare system. Methods: This is a retrospective review of all transabdominal preperitoneal robotic inguinal hernia repairs performed by 10 general surgeons from July 2015 to September 2018. Patients requiring conversion to an open procedure or undergoing simultaneous procedures were excluded. The data was divided to compare each surgeon’s initial 20 cases to their subsequent cases. Direct operative cost was calculated based on the sum of supplies used intra-operatively. Multivariate analysis, using a generalized estimating equation, was adjusted for laterality and resident involvement to evaluate outcomes. Results: Robotic inguinal hernia repairs were divided into two groups: early experience (n = 167) and late experience (n = 262). The late experience had a shorter mean operative time by 17.6 min (confidence interval: 4.06 – 31.13, p = 0.011), a lower mean direct operative cost by $538.17 (confidence interval: 307.14 – 769.20, p < 0.0001), and fewer postoperative complications (p = 0.030) on multivariate analysis. Thirty-day readmission rates were similar between both groups. Conclusion: Increasing surgeon experience with robotic inguinal hernia repair is associated with a predictable reduction in operative time, complication rates, and direct operative cost per case. Thirty-day readmission rates are not affected by the learning curve.

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Robotic Inguinal vs Transabdominal Laparoscopic Inguinal Hernia Repair

et al. 2020

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IMPORTANCE Despite rapid adoption of the robotic platform for inguinal hernia repair in the US, to date, no level I trials have ever compared robotic inguinal hernia repair to laparoscopic repair. This multicenter randomized clinical trial is the first to compare the robotic platform to laparoscopic approach for minimally invasive inguinal hernia repair.OBJECTIVE To determine whether the robotic approach to inguinal hernia repair results in improved postoperative outcomes compared with traditional laparoscopic inguinal hernia repairs. DESIGN, SETTING, AND PARTICIPANTSThis multicenter, single-blinded, prospective randomized clinical pilot study was conducted from April 2016 to April 2019, with a follow-up duration of 30 days in 6 academic and academic-affiliated sites. Enrolled in this study were 113 patients with a unilateral primary or recurrent inguinal hernia. After exclusions 102 remained for analysis.INTERVENTIONS Standard laparoscopic transabdominal preperitoneal repair or robotic transabdominal preperitoneal repair. MAIN OUTCOMES AND MEASURESMain outcomes included postoperative pain, health-related quality of life, mobility, wound morbidity, and cosmesis. Secondary outcomes included cost, surgeon ergonomics, and surgeon mental workload. A primary outcome was not selected because this study was designed as a pilot study. The hypothesis was formulated prior to data collection.RESULTS A total of 102 patients were included in the study (54 in the laparoscopic group, mean [SD] age, 57.2 [13.3] years and 48 [88.9%] male; 48 in the robotic group, mean [SD] age, 56.1 [14.1] years and 44 [91.6%] male). There were no differences at the preoperative, 1-week, or 30-day points between the groups in terms of wound events, readmissions, pain as measured by the Visual Analog Scale, or quality of life as measured by the 36-Item Short Form Health Survey. Compared with traditional laparoscopic inguinal hernia repair, robotic transabdominal preperitoneal repair was associated with longer median (interquartile range) operative times (75.5 [59.0-93.8] minutes vs 40.5 [29.2-63.8] minutes, respectively; P < .001), higher median (interquartile range

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Robotic-assisted versus laparoscopic unilateral inguinal hernia repair: a comprehensive cost analysis

Cited by 58 publications

References 34 publications

Crucial anatomy and technical cues for laparoscopic transabdominal preperitoneal repair: Advanced manipulation for groin hernias in adults

Crucial anatomy and technical cues for laparoscopic transabdominal preperitoneal repair: Advanced manipulation for groin hernias in adults

Robotic Inguinal Hernia Repair Outcomes: Operative Time and Cost Analysis

Robotic Inguinal vs Transabdominal Laparoscopic Inguinal Hernia Repair

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