Economic assessment of starting robot-assisted laparoscopic inguinal hernia repair in a single-centre retrospective comparative study: the EASTER study

Abstract

Background There has been a rapid adoption of robot-assisted laparoscopic inguinal hernia repair in the USA, despite a lack of proven clinical advantage and higher material cost. No studies have been published regarding the cost and outcome of robotic inguinal hernia surgery in a European Union setting. Methods A retrospective comparative study was performed on the early outcome and costs related to laparoscopic inguinal hernia repair, with either conventional or robot-assisted surgery. Results The study analysed 676 patients undergoing laparoscopic inguinal hernia repair (272 conventional and 404 robotic repairs). Conventional laparoscopic and robotic repair groups were comparable in terms of duration of surgery (57.6 versus 56.2 min respectively; P = 0.224), intraoperative complication rate (1.1 versus 1.2 per cent; P = 0.990), in-hospital complication rate (4.4 versus 4.5 per cent; P = 0.230) and readmission rate (3.3 versus 1.2 per cent; P = 0.095). There was a significant difference in hospital stay in favour of the robotic approach (P = 0.014), with more patients treated on an outpatient basis in the robotic group (59.2 per cent versus 70.0 per cent for conventional repair). At 4-week follow-up, equal numbers of seromas or haematomas were recorded in the conventional laparoscopic and robotic groups (13.3 versus 15.7 per cent respectively; P = 0.431), but significantly more umbilical wound infections were seen in the conventional group (3.0 per cent versus 0 per cent in the robotic group; P = 0.001). Robotic inguinal hernia repair was significantly more expensive overall, with a mean cost of €2612 versus €1963 for the conventional laparoscopic approach (mean difference €649; P < 0.001). Conclusion Robot-assisted laparoscopic inguinal hernia repair was significantly more expensive than conventional laparoscopy. More patients were treated as outpatients in the robotic group. Postoperative complications were infrequent and mild.

Robotic operations in urgent general surgery: a systematic review

“…We identified eight reports of urgent robotic operations for hernias (Table 4 ). Four studies retrospectively analyzed urgent hernia operations, two of which were controlled studies [ 25 , 40 , 41 ]. In addition, we identified a database analysis that included urgent robotic hiatal hernia operations [ 27 ].…”

“…Lap. Vs. Open n.d No 2% overall complications; 0.1% ( n = 1) CD V More urgent and severe ill cases in open; robotic less complication than lap/open 1488 open 6774 lap n.d Muhonen et al [ 70 ] CS n.d 1 – Incarcerated paraduodenal hernia Da Vinci Yes No complications 2 lap No conversions Muysoms et al [ 41 ] R-NRC 1/2016–12/2019 8 396 Robotic vs. Lap.…”

“…For urgent robotic hernia operations, the published complication rates were very heterogeneous; the database analysis of Hosein et al reported one death (0.1%) and an overall complication rate of 2% [ 27 ]. Muysoms et al reported 3.5% minor and 0.2% major complications [ 41 ]. Kudsi et al published a complication rate of 36.6% (23% minor and 13% major complications); however, this rate was significantly lower than that in the open surgery subgroup of Clavien–Dindo grade ≥ 3 complications [ 26 ].…”

“…For urgent robotic hernia operations, the published complication rates were very heterogeneous; the database analysis of Hosein et al reported one death (0.1%) and an overall complication rate of 2% [27]. Muysoms interesting outcome was the significantly shorter hospital stay but higher costs and the recurrence rate of 3.2% reported by Myosoms et al [41]. All studies emphasized that the interventions were technically feasible using an SR.…”

Robotic-assisted inguinal hernia repair: A historical review

“…They reported that the average direct cost per case in the laparoscopic repair group was $3216, compared with $3479 in the robotic group. Muysouni and colleagues reported that robot-assisted laparoscopic inguinal hernia repair was significantly more expensive than conventional laparoscopy [24]. Contributing factors to the high cost include purchasing the robot by the healthcare institution, maintenance costs, disposable materials, and longer operative times [25].…”