Robotic ventral hernia repair: fewer complications in some comparisons, longer operations

Design

Systematic review and meta-analysis, four technique comparisons

Population

Adults undergoing ventral hernia repair in comparative studies

Primary outcome

Overall complications, length of stay, operative time

Effect

rTAR vs open TAR complications OR 0.23 (0.11–0.51), stay −4.37 days; rTAPP vs IPUM OR 0.54 (0.33–0.90)

This SAGES systematic review and meta-analysis, published on 28 September, compared four robotic ventral hernia techniques with laparoscopic or open equivalents.

Robotic transversus abdominis release was associated with fewer complications than open release (OR 0.23) and about four days shorter stay, but operations took about 82 minutes longer. Robotic transabdominal preperitoneal repair had fewer complications (OR 0.54), readmissions and wound infections than laparoscopic intraperitoneal mesh. Robotic intraperitoneal mesh showed no clear difference in complications against laparoscopy (OR 0.59, interval 0.09 to 3.78) and took about an hour longer. Robotic retrorectus repair shortened stay by a day but showed a trend towards more complications.

The authors caution that most included studies were at high risk of bias. The pattern favours robotic approaches for complex open-equivalent repairs, where the comparison is with a large incision, more than for simple intraperitoneal mesh repairs.

• For component separation, robotic release was linked to fewer complications and shorter stay than open release.
• For simple intraperitoneal mesh repair, the robot added about an hour without a clear complication benefit.
• Plan theatre time for longer robotic operations.
• Treat these estimates as provisional; most source studies were at high risk of bias.

Why it matters

The benefit of the robot in hernia surgery seems to depend on what it replaces, an open incision or a laparoscope.

Don't overread it

The underlying studies were mostly non-randomised and at high risk of bias.

The statistics, in plain English

A confidence interval from 0.09 to 3.78 is so wide that the true effect could be a large reduction or a large increase in complications; it shows no clear difference. By contrast, 0.11 to 0.51 for robotic versus open release excludes no effect.

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