Inguinal Hernia Repair: Is There A Benefit To Using The Robot?

Eric J Charles, MD, J Hunter Mehaffey, MD, Carlos A Tache-Leon, MD, Peter T Hallowell, MD, Robert G Sawyer, MD, Zequan Yang, MD. University of Virginia Health System

Introduction: The number of robotic surgical procedures performed in the United States is constantly rising. Robotic surgery provides the surgeon with improved dexterity and visualization capabilities compared with conventional methods. We hypothesized that outcomes after inguinal hernia repair using the robot would be superior to outcomes after laparoscopic or open repair.

Methods and Procedures: All patients undergoing inguinal hernia repair at a single-institution between 2012-2016 were identified using institutional American College of Surgeons National Surgical Quality Improvement Program data. All cases with robotic assist were identified using a prospectively collected dataset. Demographics along with preoperative, intraoperative, and postoperative characteristics and outcomes were evaluated based on method of inguinal hernia repair (robotic, laparoscopic, or open). Categorical variables were analyzed by Chi-square test and continuous variables using Mann-Whitney U.

Results: A total of 510 patients were identified, 69 (13.8%) robotic, 241 (48.1%) laparoscopic, and 191 (38.1%) who underwent open inguinal hernia repair. There were no demographic differences between the groups in terms of sex, race, body mass index, hospital status (inpatient/outpatient), or functional health status, but there was a significant difference in American Society of Anesthesiologists classification and age (Table 1). There were also no differences in prevalence of preoperative comorbidities, including hypertension, chronic obstructive pulmonary disease, diabetes mellitus, heart failure and kidney failure. The majority of patients received only an inguinal hernia repair and no other concurrent operation (Robot: 98.6% [68] vs. Lap: 99.2% [239] vs. Open: 98.4% [188], p=0.76). Rates of postoperative occurrences (complications, readmissions, and death) were similar between the groups as seen in Table 1. There were no operative mortalities and all patients except one were discharged home the same day. Although rare, there was a significant difference in rate of postoperative skin and soft tissue infection (Robot: 2.9% [2] vs. Lap: 0% [0] vs. Open: 0.5% [1], p=0.02). Median [IQR] operative duration was also significantly different depending on method of inguinal hernia repair (Robot: 105 [76-146] vs. Lap: 81 [61-103] vs. Open: 71 [56-88] minutes, p<0.001). There were no hernia recurrences within one month after repair.

Conclusions: Surgeon comfort level and patient preference should dictate whether inguinal hernia repair is approached robotically. Longer operative duration during robotic repair may contribute to higher rates of skin and soft tissue infection. As use of the robot becomes more routine and robot access becomes more ubiquitous, operative times will likely decrease to a level comparable with laparoscopic repair.