Clinical outcomes and cost of robotic ventral hernia repair: systematic review

Background Robotic ventral hernia repair (VHR) has seen rapid adoption, but with limited data assessing clinical outcome or cost. This systematic review compared robotic VHR with laparoscopic and open approaches. Methods This systematic review was undertaken in accordance with PRISMA guidelines. PubMed, MEDLINE, Embase, and Cochrane databases were searched for articles with terms relating to 'robot-assisted', 'cost effectiveness', and 'ventral hernia' or 'incisional hernia' from 1 January 2010 to 10 November 2020. Intraoperative and postoperative outcomes, pain, recurrence, and cost data were extracted for narrative analysis. Results Of 25 studies that met the inclusion criteria, three were RCTs and 22 observational studies. Robotic VHR was associated with a longer duration of operation than open and laparoscopic repairs, but with fewer transfusions, shorter hospital stay, and lower complication rates than open repair. Robotic VHR was more expensive than laparoscopic repair, but not significantly different from open surgery in terms of cost. There were no significant differences in rates of intraoperative complication, conversion to open surgery, surgical-site infection, readmission, mortality, pain, or recurrence between the three approaches. Conclusion Robotic VHR was associated with a longer duration of operation, fewer transfusions, a shorter hospital stay, and fewer complications compared with open surgery. Robotic VHR had higher costs and a longer operating time than laparoscopic repair. Randomized or matched data with standardized reporting, long-term outcomes, and cost-effectiveness analyses are still required to weigh the clinical benefits against the cost of robotic VHR. Ventral hernias affect around one-quarter of adults, and incisional hernias develop in 10-15 per cent of open abdominal incisions. Robotic repair has seen widespread adoption globally, yet there are limited data assessing its clinical or cost outcomes. In this systematic review, the evidence shows that robotic ventral hernia repair is associated with a longer duration of operation, fewer transfusions, shorter hospital stay, and lower total complication rates compared with open repair. Robotic ventral hernia repair has greater costs and a longer operating time than laparoscopic repair. Further randomized and matched data with standardized reporting, long-term outcomes, and cost-effectiveness analyses are required.