Advertisement

Hernia

, Volume 23, Issue 1, pp 17–27 | Cite as

Robot-assisted abdominal wall surgery: a systematic review of the literature and meta-analysis

  • N. A. HenriksenEmail author
  • K. K. Jensen
  • F. Muysoms
Review

Abstract

Purpose

The number of robot-assisted hernia repairs is increasing, but the potential benefits have not been well described. The aim of this study was to evaluate the available literature reporting on outcomes after robot-assisted hernia repairs.

Methods

This is a qualitative review and meta-analysis of papers evaluating short-term outcomes after inguinal or ventral robot-assisted hernia repair compared with either open or laparoscopic approach. The primary outcome was postoperative complications and secondary outcomes were duration of surgery, postoperative length of stay and financial costs.

Results

Fifteen studies were included. Postoperative complications were significantly decreased after robot-assisted inguinal hernia repair compared with open repair. There were no differences in complications between robot-assisted and laparoscopic inguinal hernia repair. For ventral hernia repair, sutured closure of the defect, retromuscular mesh placement and transversus abdominis release is feasible when using the robot. Length of stay was decreased by a mean of 3 days for robot-assisted repairs compared with open approach. There were no differences in postoperative complications and the operative time was significantly longer for robot-assisted ventral hernia repair compared with laparoscopic or open approach.

Conclusions

For ventral hernias that would normally require an open procedure, a robot-assisted repair may be a good option, as the use of a minimally invasive approach for these procedures decreases length of stay significantly. For inguinal hernias, the benefit of the robot is questionable. Randomized controlled trials and prospective studies are needed.

Keywords

Ventral hernia Inguinal hernia Postoperative complication Outcome Length of stay Cost 

Introduction

Since the introduction of robot-assisted laparoscopic surgery, the number of procedures in which this approach has been adopted has increased, and in recent years also included abdominal wall surgery. While some surgeons have embraced the approach, others remain skeptical as to whether or not its use is justified [1]. Literature from urologic procedures describes increased costs using a robot-assisted approach, however justified by improved peri- and postoperative outcomes [2]. In abdominal wall surgery, robot-assisted procedures seem to be performed at increasing rate in both the United States and Europe [3], however the outcomes of robotic versus open and laparoscopic surgery have not been thoroughly reported.

A robot-assisted approach offers increased range of motion of the instruments allowing for high-performance suturing of the abdominal wall making it possible to perform posterior component separation in a minimal invasive manner [4]. The position of the surgeon in the robot console compared to conventional laparoscopy could possibly improve ergonomics [5]. Conversely, disadvantages may include high financial costs, longer operative times, the need for a table side surgeon and lack of evidence that outcomes are improved.

On this basis, this qualitative review and meta-analysis was undertaken to evaluate the available literature reporting on outcomes of robot-assisted hernia repairs. The primary outcome of the meta-analysis was overall postoperative complications after robot-assisted inguinal or ventral hernia repair compared to open or laparoscopic surgery. Secondary outcomes were duration of surgery, postoperative length of stay and financial costs.

Materials and methods

A study protocol was written and registered on Prospero (CRD42017072201) before initiation of the review.

A systematic review of the literature was performed by two authors independently (NAH, KKJ) using the databases Pubmed, EMBASE, Cinahl, Web-of-Science and Google Scholar along with a cross-reference search of eligible papers. The latest literature search was conducted on 23 April, 2018.

The search string for Pubmed was: ‘(robot[All Fields] OR ("robotics"[MeSH Terms] OR "robotics"[All Fields] OR "robotic"[All Fields]) OR (robot[All Fields] AND assisted[All Fields])) AND (("hernia"[MeSH Terms] OR "hernia"[All Fields]) OR ("abdominal wall"[MeSH Terms] OR ("abdominal"[All Fields] AND "wall"[All Fields]) OR "abdominal wall"[All Fields]) OR "abdominoplasty"[MeSH Terms] OR "abdominoplasty"[All Fields] OR ("abdominal"[All Fields] AND "wall"[All Fields] AND "reconstruction"[All Fields]) OR "abdominal wall reconstruction"[All Fields]))’.

Firstly, the list of titles was screened and thereafter the abstracts were evaluated for inclusion by two authors (NAH, KKJ) independently. The papers to be included in the review were approved by the third author (FM).

As the amount of literature on the subject was assumed to be sparse, it was decided to include all types of English-language studies reporting on the outcomes of robot-assisted abdominal wall hernia repairs compared with either open or laparoscopic approach, irrespective of the study quality. The primary outcome was overall postoperative complication including surgical site occurrences and other reported events according to the Clavien–Dindo classification [4]. Secondary outcomes were operative time, postoperative length of stay and financial costs. Papers were excluded if they solely described the technique or if there was no control group. The level of evidence was evaluated according to the Oxford Level of Evidence [6].

A conventional meta-analysis was performed on short-term postoperative complications for both inguinal and ventral hernia repairs and on operative time and length of stay for ventral hernia repairs. For postoperative complications, the cumulated complication rate reported by the studies was used and reported as weighted odds ratios (OR) with 95% confidence intervals (95% CI). For operative time and length of stay, mean and standard deviations were used, and reported as mean difference with 95% CI. Authors were contacted for data if lacking in the manuscripts. The random effects model was used, heterogeneity was explored using I2 statistics and the analyses were illustrated with forest plots. The meta-analysis was performed with Review Manager Software version 5.3 (The Nordic Cochrane Centre, Copenhagen, Denmark).

Results

A total of 190 papers were identified in the initial screening, and a total of 15 papers and 13 papers were included in the review and meta-analysis, respectively (Fig. 1). There were no randomized controlled trials. There were ten retrospective chart reviews and five database studies. Five papers described robot-assisted inguinal hernia repairs, but only three of them reported data to be included in the meta-analysis. The remaining papers were on robot-assisted ventral hernia repairs and all were included in the meta-analysis (Table 1). Only two studies had follow-up of more than 1 year, and therefore only short-term complications were reported.

Fig. 1

PRISMA flowchart of study selection

Table 1

Overview of included studies in review

Author

Type of study

Level of evidence

Number of patients

Type of robotic repair

Type of comparative repair

Mean length of follow-up (months)

Conclusions on postoperative complications, operative time and cost

Inguinal hernia repair

Bittner et al. [12]

Multi-center survey study

4

83/83/85

TAPP

Laparoscopic and open

1

Less pain and activity disruption in robotic and laparoscopic repairs compared with open

Operative time and cost not evaluated

Charles et al. [7]

Retrospective single-center chart review

4

69/241/191

TAPP

TAPP, open

N/A

No differences in postoperative complications

Longer operative time in the robotic group

Higher cost in robotic group

Kolachalam et al. [11]

Retrospective multi-center chart review

4

148/113

TAPP

Open repair (plug and patch, Lichtenstein, Prolene hernia system)

1

Lower rate of postoperative complications in robotic group

Longer operative time in the robotic group

Cost not evaluated

Kudsi et al. [8]

Retrospective single-center chart review

4

118/157

TAPP

TEP

12

No differences in postoperative complications

No differences in operative time

Cost not evaluated

Waite et al. [10]

Retrospective single-center chart review

4

39/24

TAPP

TAPP

< 1

Less pain in robotic group

Longer operative time and faster recovery in robotic group

No difference in direct cost

Ventral hernia repair

Armijo et al. [13]

Database study

2b

465/6829/39,505

N/A

Open and laparoscopic

1

Fewer postoperative complications in robotic group compared with open repairs

More postoperative complications in robotic group compared with laparoscopic repairs

Operative time not evaluated

Direct cost highest in robotic group

Bittner et al. [4]

Retrospective single-center chart review

4

26/76

TAR

Open TAR

3

No differences in postoperative complications

Longer operative time in robotic group

Cost not evaluated

Carbonell et al. [18]

Database study (AHSQC)

2b

111/222

Retromuscular

Open retromuscular

1.5

More seromas in robotic group

Longer operative time in robotic group

Cost not evaluated

Chen et al. [16]

Retrospective single-center chart review

4

39/33

IPOM

Laparoscopic IPOM

N/A

More seromas in robotic group

Longer operative time in robotic group

Cost not evaluated

Coakley et al. [3]

Database study

2b

351/32,243

N/A

Laparoscopic

N/A

No differences in postoperative complications

Operative time not evaluated

Higher cost for robotic cases

Gonzalez et al. 2015 [15]

Retrospective single-center chart review

4

67/67

IPOM

Laparoscopic IPOM

22

No differences in postoperative complications

Longer operative time in robotic group

Cost not evaluated

Martin-del-Campo et al. 2017 [20]

Retrospective multi-center chart review

4

38/76

TAR

Open TAR

N/A

Fewer postoperative complications in robotic group compared with open repairs

Longer operative time in robotic group

Cost not evaluated

Prabhu et al. 2017 [14]

Database study (AHSQC)

2b

186/452

IPOM

Laparoscopic IPOM

N/A

Fewer postoperative complications in robotic group

Longer operative time in robotic group

Cost not evaluated

Walker et al. [17]

Retrospective multi-center chart review

4

142/73

IPOM

Laparoscopic IPOM

1

Fewer surgical site occurrences in robotic group

Longer operative time in robotic group

Cost not evaluated

Warren et al. [19]

Retrospective single-center chart review

4

53/103

Retromuscular

Laparoscopic IPOM

N/A

More seromas in robotic group, fewer small bowel injuries in robotic group

Longer operative time in robotic group

No difference in direct cost

Robot-assisted inguinal hernia repair

Charles et al. [7] reported data on robot-assisted transabdominal preperitoneal (TAPP) repair compared with conventional TAPP and open unilateral inguinal hernia repair from a single center supplemented with data from the Americas Hernia Society Quality Collaborative (AHSQC). This study found a significantly higher rate of surgical site infection in the robotic group, even though the total rate was only 3%. Further, the mean duration of surgery and financial costs were increased in the robotic group.

Three smaller single-center single-surgeon series [8, 9, 10] reported that robot-assisted TAPP, totally extraperitoneal (TEP) and single-site TEP repairs were feasible without a high learning curve for a laparoscopic surgeon. Kudsi et al. [8] found no differences in postoperative complications and operation time. Waite et al. [10] reported less pain and 20 min faster recovery for patients undergoing robot-assisted TAPP compared with laparoscopic TAPP. In the TAPP group, a polypropylene mesh was fixated with tacks for the majority of the patients, whereas a self-adhering mesh was used in the robotic group. Further the duration of surgery and direct financial costs were increased in the robotic group [10].

Kolachalam et al. [11] compared robot-assisted TAPP with open repairs and reported an overall lower rate of postoperative complications within 30 days in the robotic group. These complications were mainly surgical site occurrences. The duration of surgery was significantly increased in the robotic group compared with open repair. Bittner et al. [12] performed a questionnaire study evaluating pain 1 week after inguinal hernia repair, and found significantly higher pain score for open repairs compared with laparoscopic and robotic repairs. In this study, there were no details on type of surgery, nor were duration of surgery or financial costs evaluated.

In the meta-analysis comparing robot-assisted inguinal hernia repair with an open approach, the risk of short-term postoperative complications was significantly reduced after robot-assisted repair (OR 0.26, 95% CI 0.11–0.66, P = 0.005, Fig. 2a). When comparing robot-assisted inguinal hernia repair with laparoscopic repair, there was no difference in the risk of short-term postoperative complications (OR 1.21, 95% CI 0.64–2.30, P = 0.650, Fig. 2b). There was insufficient data to perform a meta-analysis on operative time.

Fig. 2

Forest plot of short-term postoperative complications after a robot-assisted inguinal hernia repair compared with open repair and b robot-assisted inguinal hernia repair compared with laparoscopic repair

Robot-assisted ventral hernia repair

Armijo et al. [13] provided data from the Vizient database on more than 500 robot-assisted cases. Compared with open repairs, the robotic cases had fewer postoperative complications. However, the overall complication and readmission rate was slightly higher when compared with laparoscopic repairs. Further, robotic repairs had a higher direct cost compared with both open and laparoscopic repairs. Conversely, another American database study from the Nationwide Inpatient Sample, found no differences in postoperative complications when comparing robot-assisted hernia repair with laparoscopic repair, but also concluded that the cost was higher for robotic repairs [3]. Information about type of repair, size of hernia and duration of surgery was not available from the two databases [3, 13].

Another database study from AHSQC, reported fewer postoperative complications in patients undergoing robot-assisted intraperitoneal mesh placement (IPOM) compared with patients undergoing laparoscopic IPOM [14]. There were significantly more small bowel lesions in the laparoscopic group. Fascial closure was achieved in more than 90% of the robotic cases compared with some 50% of the laparoscopic cases. In most of the robotic cases, the mesh was fixated with sutures alone as opposed to tacks and sutures in the laparoscopic group. Postoperative pain was not evaluated. The median length of stay was significantly shorter in the robotic compared with the laparoscopic group (0 day versus 1 day) without increasing the rate of readmissions. Duration of surgery was significantly longer in the robotic group and costs were not evaluated.

In a small retrospective chart review, robot-assisted IPOM with closure of the defect was compared with laparoscopic IPOM without defect closure [15]. There was a tendency towards fewer postoperative complications in the robotic group, however, this finding was not significant. As in the AHSQC study, the duration of surgery was longer in the robotic group, and the financial costs were not evaluated. Chen et al. [16] reported comparable results in another small chart review comparing robot-assisted IPOM with laparoscopic IPOM; no differences in postoperative complications and significantly longer duration of surgery. Walker et al. [17] reported fewer surgical site occurrences, longer operative time and higher achievement of fascial closure in robot-assisted IPOM compared with laparoscopic IPOM.

In another database study from the AHSQC, robot-assisted retromuscular ventral hernia repair was compared with open retromuscular repair [18]. The length of stay was significantly decreased in the robotic group. There were more seromas in the robotic group, however, when comparing surgical site occurrences requiring procedural intervention, there was no difference between groups. There were significantly more cases lasting more than 240 min in the robotic group, but the data could not be included in the meta-analysis as the exact operative time was not available from the AHSQC database.

Warren et al. [19] compared robot-assisted retromuscular ventral hernia repair with laparoscopic IPOM by reviewing medical charts of consecutive cases. Similar to the findings of Prabhu et al. [14], fascial closure was achieved in the majority of the robotic cases as opposed to the laparoscopic cases. Further, there were significantly more small bowel injuries in the laparoscopic group. In the robotic group, there were more seromas, but no difference in seromas requiring intervention, in line with the findings by Carbonell et al [18]. The length of stay was significantly shorter, but the duration of surgery was longer in the robotic group. The direct cost of the procedures was comparable.

Bittner et al. [4] evaluated the first 26 robot-assisted transversus abdominis release (TAR) for complex ventral hernia repairs compared with open TAR and found no differences in postoperative complications. Martin-del-Campo et al. [20] also compared robot-assisted TAR with open approach and reported significantly fewer wound complications. Both studies reported significantly shorter length of stay, but 1 h longer duration of surgery in the robot group [12, 20].

The meta-analysis showed no differences in short-term postoperative complications when comparing robot-assisted repair with open (OR 0.60, 95% CI 0.20–1.75, P = 0.35, Fig. 3a) or laparoscopic approach (OR 0.94, 95% CI 0.49–1.81, P = 0.85, Fig. 3b). The operative time was significantly higher for robot-assisted ventral hernia repair compared with open and laparoscopic approach with a mean difference of 84 and 52 min, respectively (Fig. 4a, b). The length of stay was significantly shorter for robot-assisted ventral hernia repair compared with open repair with a mean difference of 3 days (Fig. 5a), whereas the length of stay was significantly shorter for laparoscopic repair compared with robot-assisted repair with a mean difference of 0.6 days (Fig. 5b).

Fig. 3

Forest plot of short-term postoperative complications after a robot-assisted ventral hernia repair compared with open repair and b robot-assisted ventral hernia repair compared with laparoscopic repair

Fig. 4

Forest plot of operative time after a robot-assisted ventral hernia repair compared with open repair and b robot-assisted ventral hernia repair compared with laparoscopic repair

Fig. 5

Forest plot of postoperative length of stay after a robot-assisted ventral hernia repair compared with open repair and b robot-assisted ventral hernia repair compared with laparoscopic repair

Discussion

This is the first review and meta-analysis evaluating outcomes after robot-assisted inguinal and ventral hernia repairs. Fifteen studies were included and ten of these were on ventral hernia repairs. For inguinal hernias, there was a decreased rate of short-term postoperative complications after robot-assisted repair compared with open repair. When comparing robot-assisted inguinal hernia repair with a laparoscopic approach, there was no differences in short-term complications. For ventral hernia repair, the length of stay was decreased by 3 days with a robot-assisted approach compared with open approach, though the operative time was significantly longer. There were no differences in postoperative complications comparing robot-assisted ventral hernia repair with open or laparoscopic approach.

Robot-assisted inguinal hernia repair is feasible, has a short learning curve for a laparoscopic surgeon and is comparable with laparoscopic repair in terms of postoperative complications [8, 21]. Further, a robot-assisted TAPP inguinal hernia repair decreases the rate of postoperative complications and postoperative pain as compared with an open repair [7, 11, 12]. However, this finding is not supported by a recent high-quality meta-analysis concluding that there was no difference in postoperative complications comparing laparoscopic TAPP with Lichenstein procedure for an inguinal hernia [22]. The operative time may be longer compared with open approach, but seems comparable with a laparoscopic approach, but there was insufficient data to perform a meta-analysis. It is possible that operative time is related to learning curve, and it seems that operative time improves over time [8]. Taken together, robot-assisted inguinal hernia repair is safe, but does not seem to improve short-term outcomes compared with laparoscopic repairs.

Robot-assisted ventral hernia repair was comparable to open and laparoscopic repair in terms of postoperative complications, but the operative time was significantly longer. However, compared with open approach, the length of stay was significantly decreased by a mean of 3 days [4, 18, 20]. It is likely to believe that one of the reasons for the decreased length of stay is related to less postoperative pain with a robot-assisted repair. This is supported by the finding that fewer patients in the robotic group required regional block analgesia [18]. However, prospective data are needed to further clarify this. Furthermore, fewer drains were used in the robot-assisted repairs, which could also affect the length of stay positively, but also lead to more seromas [18]. The length of stay was significantly longer for robot-assisted repairs compared with laparoscopic repair with some mean difference 0.6 days, which is probably not clinically relevant and could be subject to selection bias.

Robot-assisted ventral hernia repair offers advantages in terms of closure of the defect, retromuscular mesh placement and minimally invasive TAR [4, 14, 18, 20]. Sutured closure of the hernia defect seems to decrease recurrence rate, bulging and seroma formation [23, 24]. It is possible to close the defect laparoscopically, but compared with robot-assisted approach, the rate of achieved defect closure is significantly higher [14, 17, 19]. Retromuscular mesh placement may be advantageous, as intraperitoneal mesh placement may cause adhesions and fistulation. Even though laparoscopic TAR has been described as feasible [25], no larger series has been published to date, and no study has compared robot-assisted TAR with laparoscopic TAR. Retromuscular mesh placement and TAR are techniques that are mainly used in open ventral hernia repair, but with the robot it is achievable in a minimally invasive manner possibly decreasing operative stress and length of stay. This suggests that there is a place for robot-assisted hernia repair for larger ventral hernias.

The cost of robot-assisted hernia repair was only evaluated by five studies and only simple cost analysis was performed. Three studies reported a higher cost for robot-assisted repairs [3, 7, 13] and two studies concluded there was no difference in cost [10, 19]. Data on cost-effectiveness and cost–benefit analysis are lacking. Purchase and maintenance of the robotic system is expensive and further the time in the operating room is significantly longer [26]. Further studies are needed to clarify the cost-effectiveness in hernia repairs taking into consideration that it may be possible to perform more complex ventral hernia repairs with the robot decreasing length of stay and possibly patient outcomes.

The big challenge when evaluating outcomes after robot-assisted hernia repairs is to find a suitable control group. The robotic platform is a tool that helps the surgeon in some aspects of the laparoscopic surgery, therefore it is not surprising that outcomes are mostly comparable between robot-assisted and laparoscopic procedures. Conversely, length of stay is decreased by 3 days as compared with open repairs. This finding may not be surprising, as it is well known that a minimally invasive approach has advantages compared with open approaches [4]. But for ventral hernias, it is important to consider the new possibilities the robot offers in terms of repairing more complex hernias with a minimal invasive technique, and since these hernias are otherwise mainly repaired utilizing an open approach, comparison of robot-assisted and open repairs is warranted. However, randomized controlled trials comparing robot-assisted retromuscular mesh placement and TAR with open approach evaluating postoperative pain, cosmesis and long-term follow-up of recurrence are needed. Further, in order to make it clear if there is a place for robotic IPOM for ventral hernias and robotic TAPP for inguinal hernias, randomized controlled trials comparing these procedures with standard laparoscopic approaches are needed, evaluating patient-reported outcomes and recurrence.

There are several limitations to this review and meta-analysis. None of the studies were randomized controlled trials or prospective cohort studies. The majority of the studies were graded as level 4 evidence, and consequently this review and meta-analysis may only be considered as level 3a evidence. Data are lacking on patient-reported outcomes such as pain, cosmesis and return to daily activities. The control groups were either historic control groups or matched control groups from databases. This may have caused a selection bias, as simpler cases may be selected for robot-assisted repairs. Further, only two studies had a long-term follow-up [8, 15], leaving possible differences in recurrence rate unknown. For the meta-analysis, the cumulated postoperative complication rate was used, which is not an exact measure, but the only available measure from the studies to perform a meta-analysis. However, one patient may experience more than one complication, and it was not clear from the studies, how this was accounted for, which could have overestimated the postoperative complication rates. Further, some of the included case-series were performed by experts in hernia surgery and robotic surgery and may be biased by the fact that the authors have relevant conflicts of interest [7, 12, 19, 27]. Lastly, the learning curve for an average surgeon is unknown, and the results may not be generalizable.

Conclusions

Robot-assisted ventral hernia repair is comparable with open and laparoscopic repair considering postoperative complications. Robot-assisted ventral repair decrease length of stay significantly compared with open approach, though the operative time is longer. For ventral hernias that would normally require an open procedure, a robot-assisted repair may be a good option. For inguinal hernias, the benefit of using a robot is still questionable as compared with a laparoscopic approach. Randomized controlled trials and prospective cohort studies are needed to elucidate the role of the robot in hernia repair.

Notes

Compliance with ethical standards

Conflict of interest

NAH and KKJ declare no conflicts of interest. FM declares conflict of interest not directly related to the submitted work; grants and personal fees from Medtronic and Dynamesh and personal fees from Intuitive Surgical, CMR Surgical and Bard Davol, no funding was received for the current work.

Ethical approval

Approval from the institutional review board was not required for this study.

Human and animal rights

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

For this retrospective review, formal consent is not required

References

  1. 1.
    Telem DA (2018) Is robotic surgery the future for abdominal wall hernia repair? Not so fast. Ann Surg 267(2):218–219.  https://doi.org/10.1097/SLA.0000000000002336 CrossRefPubMedGoogle Scholar
  2. 2.
    Huang X, Wang L, Zheng X, Wang X (2017) Comparison of perioperative, functional, and oncologic outcomes between standard laparoscopic and robotic-assisted radical prostatectomy: a systemic review and meta-analysis. Surg Endosc 31(3):1045–1060.  https://doi.org/10.1007/s00464-016-5125-1 CrossRefPubMedGoogle Scholar
  3. 3.
    Coakley KM, Sims SM, Prasad T, Lincourt AE, Augenstein VA, Sing RF, Heniford BT, Colavita PD (2017) A nationwide evaluation of robotic ventral hernia surgery. Am J Surg 214(6):1158–1163.  https://doi.org/10.1016/j.amjsurg.2017.08.022 CrossRefPubMedGoogle Scholar
  4. 4.
    Bittner JG, Alrefai S, Vy M, Mabe M, Del Prado PAR, Clingempeel NL (2017) Comparative analysis of open and robotic transversus abdominis release for ventral hernia repair. Surg Endosc.  https://doi.org/10.1007/s00464-017-5729-0 Google Scholar
  5. 5.
    Sanchez A, Rodriguez O, Jara G, Sanchez R, Vegas L, Rosciano J, Estrada L (2018) Robot-assisted surgery and incisional hernia: a comparative study of ergonomics in a training model. J Robot Surg.  https://doi.org/10.1007/s11701-017-0777-y Google Scholar
  6. 6.
  7. 7.
    Charles EJ, Mehaffey JH, Tache-Leon CA, Hallowell PT, Sawyer RG, Yang Z (2017) Inguinal hernia repair: is there a benefit to using the robot? Surg Endosc.  https://doi.org/10.1007/s00464-017-5911-4 PubMedCentralGoogle Scholar
  8. 8.
    Kudsi OY, McCarty JC, Paluvoi N, Mabardy AS (2017) Transition from laparoscopic totally extraperitoneal inguinal hernia repair to robotic transabdominal preperitoneal inguinal hernia repair: a retrospective review of a single surgeon’s experience. World J Surg.  https://doi.org/10.1007/s00268-017-3998-3 PubMedGoogle Scholar
  9. 9.
    Tran H (2011) Robotic single-port hernia surgery. J Soc Laparoendosc Surg 15(3):309–314.  https://doi.org/10.4293/108680811X13125733356198 CrossRefGoogle Scholar
  10. 10.
    Waite KE, Herman MA, Doyle PJ (2016) Comparison of robotic versus laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair. J Robot Surg 10(3):239–244.  https://doi.org/10.1007/s11701-016-0580-1 CrossRefPubMedGoogle Scholar
  11. 11.
    Kolachalam R, Dickens E, D’Amico L, Richardson C, Rabaza J, Gamagami R, Gonzalez A (2017) Early outcomes of robotic-assisted inguinal hernia repair in obese patients: a multi-institutional, retrospective study. Surg Endosc.  https://doi.org/10.1007/s00464-017-5665-z PubMedGoogle Scholar
  12. 12.
    Bittner Iv JG, Cesnik LW, Kirwan T, Wolf L, Guo D (2018) Patient perceptions of acute pain and activity disruption following inguinal hernia repair: a propensity-matched comparison of robotic-assisted, laparoscopic, and open approaches. J Robot Surg.  https://doi.org/10.1007/s11701-018-0790-9 PubMedCentralGoogle Scholar
  13. 13.
    Armijo P, Pratap A, Wang Y, Shostrom V, Oleynikov D (2017) Robotic ventral hernia repair is not superior to laparoscopic: a national database review. Surg Endosc.  https://doi.org/10.1007/s00464-017-5872-7 Google Scholar
  14. 14.
    Prabhu AS, Dickens EO, Copper CM, Mann JW, Yunis JP, Phillips S, Huang LC, Poulose BK, Rosen MJ (2017) Laparoscopic vs robotic intraperitoneal mesh repair for incisional hernia: an americas hernia society quality collaborative analysis. J Am Coll Surg.  https://doi.org/10.1016/j.jamcollsurg.2017.04.011 Google Scholar
  15. 15.
    Gonzalez AM, Romero RJ, Seetharamaiah R, Gallas M, Lamoureux J, Rabaza JR (2015) Laparoscopic ventral hernia repair with primary closure versus no primary closure of the defect: potential benefits of the robotic technology. Int J Med Robot 11(2):120–125.  https://doi.org/10.1002/rcs.1605 CrossRefPubMedGoogle Scholar
  16. 16.
    Chen YJ, Huynh D, Nguyen S, Chin E, Divino C, Zhang L (2017) Outcomes of robot-assisted versus laparoscopic repair of small-sized ventral hernias. Surg Endosc 31(3):1275–1279.  https://doi.org/10.1007/s00464-016-5106-4 CrossRefPubMedGoogle Scholar
  17. 17.
    Walker PA, May AC, Mo J, Cherla DV, Santillan MR, Kim S, Ryan H, Shah SK, Wilson EB, Tsuda S (2018) Multicenter review of robotic versus laparoscopic ventral hernia repair: is there a role for robotics? Surg Endosc 32(4):1901–1905.  https://doi.org/10.1007/s00464-017-5882-5 CrossRefPubMedGoogle Scholar
  18. 18.
    Carbonell AM, Warren JA, Prabhu AS, Ballecer CD, Janczyk RJ, Herrera J, Huang LC, Phillips S, Rosen MJ, Poulose BK (2017) Reducing length of stay using a robotic-assisted approach for retromuscular ventral hernia repair: a comparative analysis from the Americas Hernia Society Quality Collaborative. Ann Surg.  https://doi.org/10.1097/SLA.0000000000002244 PubMedGoogle Scholar
  19. 19.
    Warren JA, Cobb WS, Ewing JA, Carbonell AM (2017) Standard laparoscopic versus robotic retromuscular ventral hernia repair. Surg Endosc 31(1):324–332.  https://doi.org/10.1007/s00464-016-4975-x CrossRefPubMedGoogle Scholar
  20. 20.
    Martin-Del-Campo LA, Weltz AS, Belyansky I, Novitsky YW (2018) Comparative analysis of perioperative outcomes of robotic versus open transversus abdominis release. Surg Endosc 32(2):840–845.  https://doi.org/10.1007/s00464-017-5752-1 CrossRefPubMedGoogle Scholar
  21. 21.
    Tran H (2011) Safety and efficacy of single incision laparoscopic surgery for total extraperitoneal inguinal hernia repair. J Soc Laparoendosc Surg 15(1):47–52.  https://doi.org/10.4293/108680811X13022985131174 CrossRefGoogle Scholar
  22. 22.
    Scheuermann U, Niebisch S, Lyros O, Jansen-Winkeln B, Gockel I (2017) Transabdominal preperitoneal (TAPP) versus Lichtenstein operation for primary inguinal hernia repair—a systematic review and meta-analysis of randomized controlled trials. BMC Surg 17(1):55.  https://doi.org/10.1186/s12893-017-0253-7 CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Baker JJ, Oberg S, Andresen K, Klausen TW, Rosenberg J (2018) Systematic review and network meta-analysis of methods of mesh fixation during laparoscopic ventral hernia repair. Br J Surg 105(1):37–47.  https://doi.org/10.1002/bjs.10720 CrossRefPubMedGoogle Scholar
  24. 24.
    Tandon A, Pathak S, Lyons NJ, Nunes QM, Daniels IR, Smart NJ (2016) Meta-analysis of closure of the fascial defect during laparoscopic incisional and ventral hernia repair. Br J Surg 103(12):1598–1607.  https://doi.org/10.1002/bjs.10268 CrossRefPubMedGoogle Scholar
  25. 25.
    Belyansky I, Zahiri HR, Park A (2016) Laparoscopic transversus abdominis release, a novel minimally invasive approach to complex abdominal wall reconstruction. Surg Innov 23(2):134–141.  https://doi.org/10.1177/1553350615618290 CrossRefPubMedGoogle Scholar
  26. 26.
    Turchetti G, Palla I, Pierotti F, Cuschieri A (2012) Economic evaluation of da Vinci-assisted robotic surgery: a systematic review. Surg Endosc 26(3):598–606.  https://doi.org/10.1007/s00464-011-1936-2 CrossRefPubMedGoogle Scholar
  27. 27.
    Kudsi OY, McCarty JC, Paluvoi N, Mabardy AS (2017) Transition from laparoscopic totally extraperitoneal inguinal hernia repair to robotic transabdominal preperitoneal inguinal hernia repair: a retrospective review of a single surgeon’s experience. World J Surg 41(9):2251–2257.  https://doi.org/10.1007/s00268-017-3998-3 CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of SurgeryZealand University HospitalKoegeDenmark
  2. 2.Digestive Disease CenterBispebjerg University HospitalCopenhagenDenmark
  3. 3.Department of Suregery, Maria MiddelaresGhentBelgium

Personalised recommendations