First 100 consecutive robotic inguinal hernia repairs at a Veterans Affairs hospital

Abstract

The utilization of robotics in general surgery has increased significantly including usage in the Veterans Affairs (VA) system. We implemented a robotic inguinal hernia repair (RIHR) program in our VA hospital and report on initial experience with safety and outcomes. The first 100 consecutive RIHR at a VA hospital were reviewed and compared against the results of contemporaneous open inguinal hernia repair (OIHR). Data were collected for operative characteristics, surgical complications and pain related outcomes. Overall, operative times for OIHR were less than RIHR (83.7 vs. 109.7 min, p < 0.0001); however, there was no difference in operative time for bilateral repairs (121.5 vs. 121.9 min, p = ns). Complication rates were similar between the groups. RIHR patients had less pain at POD 1 than OIHR patients (p = 0.05). RIHR were less likely to have multiple post-op visits for pain than OIHR patients (p = 0.003). RIHR can be implemented in the VA system with acceptable surgical outcomes. RIHR may be associated with less post-operative pain in the early post-operative period.

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

“…17 Of the remaining 22 observational studies, 6 were conference abstracts. 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.…”

“…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.…”

“…Large differences (>20%) in or lack of reporting of the laterality of the hernia repairs also introduced confounding bias in 10 studies. 20,23,24,26,28,30,32,33,35,39 Selection bias for the majority of studies was low; however, 8 studies were judged to have greater risk of bias due to study-specific patient exclusion criteria. 20,24,29,[34][35][36][37]39 Nine studies also disclosed author involvement of various extents with Intuitive Surgical, Inc. [18][19][20][21][22]29,31,34,38 Finally, the study by Bittner and colleagues 20 warrants special mention for serious methodologic limitations due to it being a retrospective survey of a random sample from a web-based research panel of patient-reported outcomes, with a low response rate and high recall bias.…”

“…Six studies demonstrated increased operative times with robot-assisted inguinal hernia repair compared with open by a median of 43 minutes (range 10 to 71 minutes) (Table 3). 21,22,24,26,30,32 One study performed a subgroup analysis based on laterality and demonstrated a significantly longer operative duration with robotic unilateral inguinal 30 Of the 12 studies that assessed operative times between robot-assisted inguinal hernia repair compared with laparoscopic, 11 studies, including the RCT, reported significantly longer operative duration with unilateral robotic inguinal hernia repair by a median of 24 minutes (range 9 to 62 minutes). 17,18,21,24,26,27,[32][33][34]38,39 Four studies performed subgroup analyses based on laterality, of which 3 studies demonstrated a longer operative time within both robot-assisted unilateral and bilateral inguinal hernia repair.…”

“…Seven studies evaluated pain outcomes between robotic and open inguinal hernia repairs (Table 4). Of the 6 studies that assessed perioperative or short-term pain outcomes, 3 lower quality studies found decreased pain with robotic surgery compared with open hernia repair, 20,26,30 while the remaining 3 studies did not find a difference. 22,24,35 Four studies assessed longer-term pain outcomes, of which 1 study detected fewer visits due to pain after robotic surgery, although there was no difference in other pain metrics within the same study, such as need for additional narcotic prescriptions or pain clinic referral.…”