Results of robotic TAPP and conventional laparoscopic TAPP in an outpatient setting: a cohort study in Switzerland

Abstract

Purpose Recently, robotic surgery has been increasingly performed in hernia surgery. Although feasibility and safety of robot-assisted inguinal hernia repair in an inpatient setting have been already shown, its role in outpatient hernia surgery has not yet been investigated. Thus, this study aimed to compare robot-assisted TAPP (r-TAPP) and conventional laparoscopic TAPP (l-TAPP) in an outpatient setting. Methods A prospective database of patients with inguinal hernia treated by l-TAPP or r-TAPP in an outpatient setting during a 1-year period was analyzed in a comparative cohort study. All patients underwent a check-up appointment with their surgeon within 3 days and 6 weeks postoperatively. Data on surgical time, perioperative complications, and postoperative pain were collected. Pain was recorded by using a Verbal Rating Scale (VRS). Results Overall, outpatient laparoendoscopic inguinal hernia repair was performed in 58 patients (29 l-TAPP; 29 r-TAPP). Mean age was 57 years (21–81), mean BMI 24.5 kg/m2 (19–33) with no differences between both groups. Most patients reported none or only a low postoperative pain level in both groups (89.6% in l-TAPP group; 100% in r-TAPP), while there was a trend for less pain after r-TAPP. In both groups, there was one case of postoperative hematoma, which was successfully treated by conservative means. No other complications occurred during follow-up in either group and there was no 30-day-readmission, no unplanned overstay or any 30-day mortality in the cohort. Conclusion Robot-assisted inguinal hernia surgery can be safely performed in an outpatient setting with a tendency to less pain when compared to the conventional laparoscopic technique. Cost-effectiveness and cost-coverage of outpatient robot-assisted inguinal hernia surgery must be further investigated in times of limited health cost resources and diagnosis-related medical reimbursements.

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 .…”

“…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.…”

Comparison of modified tumescent and conventional laparoscopic transabdominal preperitoneal inguinal hernia repair: a retrospective clinical study

“…TAPP repair has been shown to be associated with a reduced incidence of postoperative complications and discomfort compared with open mesh repair. [13][14][15][16] The standard approaches for TAPP hernia repair are characterized by their high level of complexity and steep learning curve. 17 Furthermore, hernia recurrence is not infrequent when the procedure is conducted by surgeons lacking the necessary skills and expertise.…”

Robotic-assisted inguinal hernia repair: A historical review

“…Choosing the best technique for repairing an inguinal hernia is challenging because the available data is controversial. To date, numerous observational studies [5][6][7][8] and one randomized trial have failed to demonstrate that short-term and functional outcomes after robotic surgery are superior to those of laparoscopic surgery for patients with inguinal hernia. The aim of the review is to provide an overview about the current practice for inguinal hernia repair with the focus on robotic approach.…”