D. T. Lammers1, J. P. Kuckelman1, J. Bingham1 1Madigan Army Medical Center,Department Of General Surgery,Tacoma, WA, USA
Introduction:
Inguinal hernia repair is one of the most common surgical procedures performed worldwide. The development of the robotic assisted inguinal hernia repair theoretically allows for optical and technical advantages over laparoscopic surgery with improved post-operative pain and recovery over open methods. These theories are yet to be clearly described with a paucity of data comparing robotic inguinal hernia repairs to other commonly performed methods. We characterize our experience with robotic assisted inguinal hernia repair compared to open and laparoscopic approaches.
Methods:
Retrospective review using a prospectively collected data base of all inguinal hernia repairs over 7 years at a single institution. Data was grouped to compare between robotic, laparoscopic and open cases. Comparisons were made for all perioperative data, including patient demographics, intra and post-operative outcomes. Statistical significance was set at a p value of 0.05 comparing mean using ANOVA and Chi-square analysis.
Results:
A total of 277 matched cases met inclusion criteria and were compared. There were no statistical differences in age, gender, or preoperative comorbidities between groups. BMI was significantly higher in the robotic group when compared to laparoscopic and open inguinal hernia repairs at 31 vs 26 and 27, respectively (p=0.001). Operative times were found to be significantly longer with robotic cases at an average of 146 minutes vs 75 minutes in the open group and 86 minutes with laparoscopic cases (p=<0.001). Greater than 30 day follow up was accomplished in 95% of patients. Readmission within 30 days occurred more frequently with the open group (2.4%) when compared to both laparoscopic (1.2%) and robotic (0%) groups (p=0.03). There were no differences seen between groups with regards to post-operative complications including surgical site infections, return to the operating room, length of stay, thromboembolic events, and death (Figure 1).
Conclusion:
Robotic inguinal hernia repair was preferentially performed in larger patients with significantly better or equivalent outcomes when compared to laparoscopic or open inguinal hernia repairs, although associated with longer operative times. Robotic repairs are a viable and safe option for inguinal hernias.
