Robotic versus laparoscopic transabdominal preperitoneal (TAPP) approaches to bilateral hernia repair: a multicenter retrospective study using propensity score matching analysis

Abstract

Background Since the introduction of minimally invasive surgery, new techniques like transabdominal preperitoneal (TAPP) repair have progressively gained acceptance for the treatment of groin hernia. Laparoscopic TAPP (LTAPP) is recommended for bilateral repairs. Likewise, the introduction of robotic platforms has promised additional surgical benefits for robotic TAPP (RTAPP), which are yet to be confirmed. This study compared multicenter data obtained from patients undergoing bilateral inguinal hernia repair with RTAPP, performed during the preliminary learning curve period, versus conventional LTAPP. Materials and methods All consecutive bilateral inguinal hernia patients from four Italian centers between June 2015 and July 2020 were selected. A propensity score model was used to compare patients treated with LTAPP versus RTAPP, considering sex, age, body mass index, current smoking status, overall comorbidity, hernia classification (primary or recurrent), and associated procedures as covariates. After matching, intraoperative details and postoperative outcomes were evaluated. Results In total, 275 LTAPP and 40 RTAPP were performed. After matching, 80 and 40 patients were allocated to the LTAPP and RTAPP cohorts, respectively. No intraoperative complications or conversion to open surgery occurred. However, a longer operative time was recorded in the RTAPP group (79 ± 21 versus 98 ± 29 min; p < 0.001). Postoperative visual analog scale (VAS) pain scores (p = 0.13) did not differ and complication rates were similar. There were no clinical recurrences in either group, with mean follow-up periods of 52 ± 14 (LTAPP) and 35 ± 8 (RTAPP) months. A statistical difference in length of hospital stay was found between the groups (1.05 ± 0.22 vs 1.50 ± 0.74 days; p < 0.001). Conclusion In this patient population, outcomes for bilateral inguinal hernia repair appear comparable for RTAPP and LTAPP, except for a shorter recovery after laparoscopic surgery. A longer operative time for robotic surgery could be attributable to the learning curve period of each center.

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

“…Among the included studies, 2 articles [ 16 , 21 ] were randomized controlled trials (RCTs) with a score of 4, indicating high quality. 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 ].…”

“…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 .…”

“…Three studies [ 12 , 13 , 20 ] reported hospital stay. There was statistical heterogeneity among the studies (P = 0.05, I2 = 67%).…”

“…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%).…”

Safety and short‐term outcomes of robotic‐assisted transabdominal preperitoneal repair for inguinal hernia in pioneering hospitals in Japan: A nationwide retrospective cohort study

“…2 However, R-TAPP has been noted to provide minimal clinical benefit compared to laparoscopic transabdominal preperitoneal hernia repair (L-TAPP) and open hernia repair. [3][4][5] The RIVAL study, the only randomized control trial, compared the results of R-TAPP with those of L-TAPP, and showed that R-TAPP was associated with longer surgical time, higher cost, and higher frustration for surgeons. 6 In addition, although several metaanalyses have been conducted, none have demonstrated the clinical superiority of R-TAPP.…”