Kevin Bain, DO, Vickie Kassapidis, Vadim Meytes, DO, George Ferzli, MD. NYU Langone Hospital – Brooklyn
Background: Inguinal hernia repair is one of the most common general surgery procedures with over 600,000 performed annually in the United States. When compared to traditional open inguinal hernia repair (OIHR), laparoscopic inguinal hernia repair (LIHR) has been associated with faster postoperative recovery rates and lower postoperative pain. With advances in the robotic platform, robotic inguinal hernia repair (RIHR) is an available technique that is currently being explored. This study examines LIHR and RIHR as described in literature to see if one is superior to the other.
Study Design: Search terms: ‘‘Inguinal Hernia Repair” ‘‘Robotic Inguinal Hernia Repair,’’ ‘‘Laparoscopic Inguinal Hernia Repair.’’
A systematic search was performed in August 2017 of Medline, PubMed, and relevant journals using the above-listed search terms. Out of 80 articles found, only 8 were suitable for this content review.
Results: Operative time in RIHR averaged 99 minutes as compared to 68 minutes in LIHR. Patients undergoing RIHR had an average complication rate of 5% with a recurrence rate of 0.06%. For obese patients, a lower percentage experienced postoperative complications when undergoing RIHR as compared to OIHR (unadjusted: 2.7% vs. 11.5%, p = 0.005; and matched: 3.2 % vs. 10.8%, p = 0.047), with bilateral robotic repairs more easily conducted in obese patients (unadjusted 29.7% vs. 16.8%, p = 0.019; and unadjusted 35.1% vs. 11.5%, p < 0.0001-respectively). More complicated procedures were performed using R-TAPP (n = 11 vs. n = 1, p = 0.0001) with nearly identical (69.12 ± 35.13 min, R-TAPP; 69.05 ± 26.31, L-TEP) intraoperative and postoperative complication rates. Similarly, average pain scores in recovery (2.5 vs 3.8, p = 0.02) were significantly less after R-TAPP. However, mean operative time (77.5 vs 60.7 min, p = 0.001) and room time (109.3 vs 93.0 min, p = 0.001) were longer but with less recovery time and reported pain. Surgical complications including hematomas (3.9%), seromas (2.6%), and trocar site infection (1.3%) resolved with antibiotics, with a 2.6% postoperative complication rate.
Conclusion: RIHR repair is a safe alternative to LIHR, with fewer postoperative complications and a faster recovery time. However, operative time as well as OR room time is significantly longer, which may increase overall cost. Further high quality randomized controlled trials are needed to assess efficacy and outcomes of RIHR.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86199
Program Number: P819
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster