The paradox of the robotic approach to inguinal hernia repair in the inpatient setting

Janjua, Haroon; Cousin-Peterson, Evelena; Barry, Tara M.; Kuo, Marissa C.; Baker, Marshall S.; Kuo, Paul C.

doi:10.1016/j.amjsurg.2019.09.012

Cited by 19 publications

(21 citation statements)

References 11 publications

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“…23,26,28,32,33,37 The robotic approach was compared with the open approach in 14 studies (Table 2), [19][20][21][22][23][24][25][26][28][29][30]32,35,36 while the robotic approach was compared with the laparoscopic approach in 18 studies (Table 1). [18][19][20][21][24][25][26][27][28][31][32][33][34][35][36][37][38][39] The majority of the studies were performed within the US, with 2 performed at non-US institutions. 26,34 Eight studies analyzed patients from prospectively maintained datasets.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…26,34 Eight studies analyzed patients from prospectively maintained datasets. 19,21,23,25,28,34,35,37 Five studies used propensity matching. 20,22,25,29,32 The studies varied in size from 55 to 75,981 patients.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…18,19,21,37 Of the 12 studies that examined both unilateral and bilateral repairs, 7 studies included subgroup analyses of unilateral repairs for certain outcomes. 25,27,30,31,34,36,38 The 6 studies that did not specify laterality also poorly reported the descriptive patient and hernia characteristics and are listed separately (eTables 1 and 2). 20,23,28,32,33,35 The majority of study patients undergoing the robotic approach underwent transabdominal preperitoneal (TAPP) hernia repair, but patients undergoing the laparoscopic approach experienced a mix of TAPP and totally extraperitoneal (TEP) inguinal hernia repairs.…”

Section: Study Characteristicsmentioning

confidence: 99%

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Clinical and Cost Outcomes of Robot-Assisted Inguinal Hernia Repair: A Systematic Review

Tang

Shenoy

et al. 2021

Journal of the American College of Surgeons

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Inguinal hernia repair is one of the most common general surgical procedures, with more than 20 million hernias repaired worldwide annually. 1 While most surgeons use an open approach, there has been a growth in laparoscopic and robotic techniques among unilateral, bilateral, and recurrent hernia repairs. 2,3 Advantages have been lauded, with laparoscopic and robotic repair allowing for superior visualization of bilateral groin anatomy and exploration of both inguinal and femoral spaces. Also, some reports suggest that patients may have less postoperative pain. 4 A recent study found that robotic inguinal hernia repair use increased 41-fold in Michigan (2012 to 2018). 5 Proponents of the robotic platform argue that its magnified 3-dimensional visualization, stable platform, and superior range of motion may translate into better clinical outcomes. 6 The number of robotic inguinal hernia repair procedures continues to rise despite confirmation of the clinical benefits. 7,8 The economic value of robotic surgery is also unclear. Technology acquisition and implementation require substantial upfront investment along with ongoing costs for annual maintenance contracts, instrument purchases, staff and training, infrastructure upgrades, and marketing. 9 The cost benefit in relationship to clinical outcomes associated with the use of robotic technology must be apparent to provider and patient.Two systematic reviews of robotic inguinal hernia repair were published in 2019 but are already dated, as at least 10 additional studies have since been published, including the first randomized controlled trial (RCT). 10,11 We proceeded with this systematic review to provide the most up-to-date assessment of perioperative and long-term clinical outcomes and cost for robotassisted inguinal hernia repair compared with open and laparoscopic approaches. METHODSThis review is part of a larger report commissioned by the Department of Veterans Affairs on the clinical outcomes and cost-effectiveness of robotic procedures for cholecystectomy, inguinal hernia repair, and ventral hernia repair. This systematic review is reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards, 12 and the a priori protocol was registered in PROSPERO: CRD42020156945.

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Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

See 1 more Smart Citation

Clinical and Cost Outcomes of Robot-Assisted Inguinal Hernia Repair: A Systematic Review

Tang

Shenoy

et al. 2021

Journal of the American College of Surgeons

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“… 6 As discussed earlier, previous studies have shown prolonged operative time and higher cost, while also having an improved recovery time and postoperative pain in robotic compared to laparoscopic IHR. 5 – 8 , 13 , 14 No study, with a significant population size, analyzed whether such outcomes change with a surgeon’s growing RIHR experience across the learning curve. To our knowledge, this is the largest RIHR experience in literature to address this topic.…”

Section: Discussionmentioning

confidence: 99%

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 surgery has a short, steep learning curvedsimilar to laparoscopydand surgeons have reported lower blood loss, shorter hospital length of stay, fewer complications, and earlier return to work relative to laparoscopic and open approaches across several surgical specialties, but with higher operative costs and limited high-level evidence demonstrating significant performance advantages. 10,20,21,35,36 In a large randomized trial, robotic-assisted rectal cancer resection yielded no significant advantages over laparoscopic resection. 37 Machine learning models can assess robotic operative performance and predict patient outcomes.…”

Section: Robotic Surgerymentioning

confidence: 99%