Robotic-assisted and laparoscopic hernia repair: real-world evidence from the Americas Hernia Society Quality Collaborative (AHSQC)

Phillips, Melissa S.; Kleppe, Kyle; Webb, Lars; Stewart, Thomas G.; Olson, Molly A.

doi:10.1007/s00464-020-07511-w

Cited by 18 publications

(25 citation statements)

References 20 publications

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“…Twenty-two studies were observational, of which four 22 , 34 , 36 , 37 were conference abstracts, and two 37 , 39 provided cost outcomes only. Eleven studies 12–14 , 23–25 , 27 , 29 , 30 , 36 , 39 used data from prospectively maintained databases, nine 12 , 13 , 24 , 25 , 27 , 32 , 34–36 compared robotic VHR with open repair ( Table 3 ), and 15 13 , 14 , 22 , 23 , 26 , 28–31 , 33 , 36–40 compared robotic surgery with laparoscopy. All observational studies were performed in the USA, except for two studies 27 , 35 from Austria and Australia.…”

Section: Resultsmentioning

confidence: 99%

“…All observational studies were performed in the USA, except for two studies 27 , 35 from Austria and Australia. Ten studies 12–14 , 23 , 25 , 29 , 30 , 32 , 35 , 38 were multi-institutional, 11 22 , 24 , 26–28 , 31 , 33 , 34 , 37 , 39 , 40 were from a single institution, and one study 36 did not specify the number of centres. Propensity matching was performed in six studies 23 , 25 , 30 , 32 , 36 , 38 .…”

Section: Resultsmentioning

confidence: 99%

“…Ten studies 12–14 , 23 , 25 , 29 , 30 , 32 , 35 , 38 were multi-institutional, 11 22 , 24 , 26–28 , 31 , 33 , 34 , 37 , 39 , 40 were from a single institution, and one study 36 did not specify the number of centres. Propensity matching was performed in six studies 23 , 25 , 30 , 32 , 36 , 38 . The sample size varied from 26 to 46 799 patients.…”

Section: Resultsmentioning

confidence: 99%

“…The non-matched studies had a high risk of bias, whereas the matched studies were deemed to have a moderate risk of bias. Seven 24 , 25 , 30–32 , 38 , 39 studies disclosed author involvement with Intuitive Surgical to varying extents.…”

Section: Resultsmentioning

confidence: 99%

“…Seven 12 , 24 , 25 , 32 , 34–36 of eight studies, including all three with propensity matching, demonstrated increased operating time with robotic compared with open surgery by 66–88 min, whereas there was no statistically significant difference in the remaining non-matched study 27 . For the robotic versus laparoscopic comparison, all nine studies 20 , 21 , 26 , 28 , 30 , 31 , 36 , 38 , 40 reporting duration of surgery, including two RCTs and two propensity-matched studies, reported a longer operating time with robotic VHR by a median of 54 min.…”

Section: Resultsmentioning

confidence: 99%

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Clinical outcomes and cost of robotic ventral hernia repair: systematic review

Childers

Virgilio

et al. 2021

BJS Open

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Background Robotic ventral hernia repair (VHR) has seen rapid adoption, but with limited data assessing clinical outcome or cost. This systematic review compared robotic VHR with laparoscopic and open approaches. Methods This systematic review was undertaken in accordance with PRISMA guidelines. PubMed, MEDLINE, Embase, and Cochrane databases were searched for articles with terms relating to ‘robot-assisted’, ‘cost effectiveness’, and ‘ventral hernia’ or ‘incisional hernia’ from 1 January 2010 to 10 November 2020. Intraoperative and postoperative outcomes, pain, recurrence, and cost data were extracted for narrative analysis. Results Of 25 studies that met the inclusion criteria, three were RCTs and 22 observational studies. Robotic VHR was associated with a longer duration of operation than open and laparoscopic repairs, but with fewer transfusions, shorter hospital stay, and lower complication rates than open repair. Robotic VHR was more expensive than laparoscopic repair, but not significantly different from open surgery in terms of cost. There were no significant differences in rates of intraoperative complication, conversion to open surgery, surgical-site infection, readmission, mortality, pain, or recurrence between the three approaches. Conclusion Robotic VHR was associated with a longer duration of operation, fewer transfusions, a shorter hospital stay, and fewer complications compared with open surgery. Robotic VHR had higher costs and a longer operating time than laparoscopic repair. Randomized or matched data with standardized reporting, long-term outcomes, and cost-effectiveness analyses are still required to weigh the clinical benefits against the cost of robotic VHR.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Clinical outcomes and cost of robotic ventral hernia repair: systematic review

Childers

Virgilio

et al. 2021

BJS Open

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Surgical Approach and Long-Term Recurrence After Ventral Hernia Repair

Fry,

Howard,

Thumma

et al. 2024

JAMA Surg

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ImportanceThe prevalence of robotic-assisted anterior abdominal wall (ventral) hernia repair has increased dramatically in recent years, despite conflicting evidence of patient benefit. Whether long-term hernia recurrence rates following robotic-assisted repairs are lower than rates following more established laparoscopic or open approaches remains unclear.ObjectiveTo evaluate the association between robotic-assisted, laparoscopic, and open approaches to ventral hernia repair and long-term operative hernia recurrence.Design, Setting, and ParticipantsSecondary retrospective cohort analysis using Medicare claims data examining adults 18 years and older who underwent elective inpatient ventral, incisional, or umbilical hernia repair from January 1, 2010, to December 31, 2020. Data analysis was performed from January 2023 through March 2024.ExposureOperative approach to ventral hernia repair, which included robotic-assisted, laparoscopic, and open approaches.Main Outcomes and MeasuresThe primary outcome was operative hernia recurrence for up to 10 years after initial hernia repair. To help account for potential bias from unmeasured patient factors (eg, hernia size), an instrumental variable analysis was performed using regional variation in the adoption of robotic-assisted hernia repair over time as the instrument. Cox proportional hazards modeling was used to estimate the risk-adjusted cumulative incidence of operative recurrence up to 10 years after the initial procedure, controlling for factors such as patient age, sex, race and ethnicity, comorbidities, and hernia subtype (ventral/incisional or umbilical).ResultsA total of 161 415 patients were included in the study; mean (SD) patient age was 69 (10.8) years and 67 592 patients (41.9%) were male. From 2010 to 2020, the proportion of robotic-assisted procedures increased from 2.1% (415 of 20 184) to 21.9% (1737 of 7945), while the proportion of laparoscopic procedures decreased from 23.8% (4799 of 20 184) to 11.9% (946 of 7945) and of open procedures decreased from 74.2% (14 970 of 20 184) to 66.2% (5262 of 7945). Patients undergoing robotic-assisted hernia repair had a higher 10-year risk-adjusted cumulative incidence of operative recurrence (13.43%; 95% CI, 13.36%-13.50%) compared with both laparoscopic (12.33%; 95% CI, 12.30%-12.37%; HR, 0.78; 95% CI, 0.62-0.94) and open (12.74%; 95% CI, 12.71%-12.78%; HR, 0.81; 95% CI, 0.64-0.97) approaches. These trends were directionally consistent regardless of surgeon procedure volume.Conclusions and RelevanceThis study found that the rate of long-term operative recurrence was higher for patients undergoing robotic-assisted ventral hernia repair compared with laparoscopic and open approaches. This suggests that narrowing clinical applications and evaluating the specific advantages and disadvantages of each approach may improve patient outcomes following ventral hernia repairs.

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