Initial Experience of Robot-Assisted Transabdominal Preperitoneal (TAPP) Inguinal Hernia Repair by a Single Surgeon in South Korea

Abstract

Background and Objectives: Inguinal hernia is a common surgical disease. Traditional open herniorrhaphy has been replaced by laparoscopic herniorrhaphy. Nowadays, many attempts at robotic herniorrhaphy have been reported in western countries, but there have been no reports in South Korea. The purpose of this study is to report our initial experience with robotic inguinal hernia surgery, compared to laparoscopic inguinal hernia surgery. Materials and Methods: We analyzed the clinical data from 100 patients who received inguinal hernia surgery in our hospital from November 2020 to June 2022. Fifty patients underwent laparoscopic surgery, and 50 patients underwent robotic surgery using the da Vinci Xi system. All hernia surgeries were performed by a single surgeon using the transabdominal preperitoneal (TAPP) method. Results: The mean operation time and hospital stay were not statistically different. On the first postoperative day, the visual analog scale (VAS) pain score was significantly lower in the robotic surgery group (2.9 ± 0.5 versus 2.5 ± 0.7, p = 0.015). Cumulative sum analysis revealed an approximately 12-case learning curve for robotic-assisted TAPP hernia surgery. Conclusions: Robotic-assisted TAPP inguinal hernia surgery is technically acceptable to surgeons who have performed laparoscopic inguinal hernia surgery, and the learning curve is relatively short. It is thought to be a good step toward learning other robot-assisted operations.

Meta-analysis of the effectiveness and safety of robotic-assisted versus laparoscopic transabdominal preperitoneal repair for inguinal hernia

“…Eight articles [ 12 – 15 , 17 – 20 ] were non-randomized controlled studies, and all of them received high-quality ratings based on the Newcastle-Ottawa Scale (NOS). Among these, 2 articles [ 14 , 17 ] scored 8 points, while the remaining 6 articles scored 7 points [ 12 , 13 , 15 , 18 – 20 ]. The detailed scoring results are presented in Table 1 .…”

“…A random-effects model was used to combine the effect sizes for the meta-analysis, which indicated that the cost in the RTAPP group was higher than that in the LTAPP group [MD = $4.17 thousand, 95% CI (2.59, 5.76), P < 0.00001], and this difference was statistically significant. Sensitivity analysis was conducted, and when the study by Choi 2023 [ 13 ] or Prabhu 2020 [ 21 ] was excluded, the results showed no statistically significant difference in cost between the two groups. Therefore, it suggests that the stability of the results is relatively low, and it is recommended that future researchers conduct more studies on this aspect, as shown in Fig 4 .…”

“…Five studies [ 12 , 13 , 16 , 19 , 20 ] reported the recurrence rate. The recurrence rate in the RTAPP group was 3/359 (0.8%), while in the LTAPP group, it was 4/405 (0.9%).…”

“…The remaining 19 articles underwent full-text screening, and 4 articles lacked relevant outcome measures, while 5 articles were excluded due to the absence of control groups. Following the sequential screening process described above, a total of 10 articles [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] were ultimately included. A detailed overview of the selection process is shown in Fig 1 . The basic characteristics of the included literature are provided in Table 1.…”

“…Currently, it has been successfully applied in abdominal wall incisional hernia repair, paraesophageal hernia repair, and inguinal hernia repair, demonstrating its technical advantages [9][10][11]. While several randomized controlled studies and nonrandomized controlled studies have compared RTAPP with LTAPP in the treatment of inguinal hernia [12][13][14][15][16][17][18][19][20][21], there is limited data from single-center studies, and clinical reports yield inconsistent results. By specifically focusing on TAPP procedures and including the latest studies from 2023, this meta-analysis aims to provide a comprehensive evaluation of the effectiveness and safety of RTAPP in inguinal hernia treatment.…”