Robotic Inguinal Hernia Repair Outcomes: Operative Time and Cost Analysis

Abstract

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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“…Worldwide more than 20 million inguinal hernia repairs are being performed every year [2]. With approximately 13% are recurrent [2,5,6]. The risks for hernia recurrence are multifactoral and some of them are surgical and non-surgical [5].…”

“…Both laparoscopic and robotic hernia repair are often performed in complex inguinal hernias, such as bilateral, recurrent or femoral hernias [2,5,6]. The robotic approach allows the surgeon to identify patients with mixed wall defects such as inguinal, femoral/obturator and contralateral hernias [1,6,7]. It allows for coverage of the entire myopectineal orifice with the mesh [1].…”

“…Early clinical outcomes showes no significat differences between the robotic and laparoscopic groups in postoperative pain, quality of life, mobility, esthetic outcomes, wound morbidity, and complications [9]. The disadvantages of a robotic approach are longer operation time and increased expense compared to the laparoscopic procedure [6,10,11]. The costs of robotic platforms and instruments are higher [10,12,13].…”

“…Compared to Europe, in the United States, robotic inguinal hernia repair is a very sophisticated minimally invasive technique for hernia surgery. It is very commonly performed and its use has recently increased exponentially [3,6]. In our opinion in Europe, robotic IPOM technique is performed as the last resort when the prevoius options have failed in cases of multiple recurrent hernias.…”

A New Modified Hysteroscopic-Laparoscopic Surgery for Cesarean Scar Pregnancy of Stable Type III

“…Therefore, the modified hysteroscopic-laparoscopic surgery has significant advantages in operation time. Many studies have proved the mean procedure time was positive correction with the mean total cost and complications, [15][16][17][18] regrettably, we did not include patient cost in the study. Therefore, we cannot prove that the modified surgery reduces the total cost in our study, but we believe that later studies that include this parameter will illustrate the advantages in patient costs in the modified surgery.…”