Compared with laparoscopic ventral hernia repair, robotic repair does not decrease the length of stay, while nearly doubling operating time and significantly increasing healthcare costs, according to a randomised clinical trial reported in the BMJ.
Participants deemed appropriate for elective minimally invasive ventral hernia repair (n=124) were randomised to receive robotic ventral hernia repair (n=65) or laparoscopic ventral hernia repair (n=59).
The primary outcome was the number of days in hospital within 90 days after surgery. Secondary outcomes included emergency department visits, operating room time, wound complications, hernia recurrence, reoperation, abdominal wall quality of life, and costs from the healthcare system perspective.
There was no difference between the two groups regarding the number of days in hospital (median 0 versus 0 days). Relative to secondary outcomes, no differences were noted in emergency department visits, wound complications, hernia recurrence, or reoperation. However, robotic repair had longer operative duration (141 versus 77 minutes) and increased healthcare costs.
Limitations: The study was carried out by experts in minimally invasive surgery. The advantage of robotic ventral hernia repair is seen with larger hernias.
These findings suggest that larger multicenter trials are needed before widespread adoption of robotic ventral hernia repair can be recommended.