A cost analysis of two- versus three-instrument robotic-assisted inguinal hernia repair with mesh: time is money

Contemporary inguinal hernia repair: do cost and operative time still differ by approach?

BACKGROUND

Concerns about the expense of robotic surgery for inguinal hernia repairs have emerged alongside the growing interest and skill in robotic techniques over the past decade. This study aimed to assess whether the costs of robotic inguinal hernia repairs are comparable to those of laparoscopic or open methods.

METHODS

We conducted a retrospective analysis of consecutive open, laparoscopic, and robotic inguinal hernia repairs using mesh at a single tertiary academic medical center from 2020 to 2023. We compared costs and operation times for initial unilateral and bilateral cases.

RESULTS

In unilateral repairs-open (n = 384), laparoscopic (n = 35), and robotic (n = 312)-the median operative times were 62, 67, and 67 min, respectively. Open repairs were quicker than laparoscopic (p = 0.010), but no significant difference was noted compared to robotic repairs (p = 0.066), and there was no substantial difference between laparoscopic and robotic repairs (p = 0.5). The total costs for unilateral open repairs ($11,218) were lower than the costs for laparoscopic ($13,819, p =  < 0.001) or robotic ($15,610, p =  < 0.001) repairs, with laparoscopic also being less expensive than robotic (p = 0.019). For bilateral repairs, the median operative times were 104 min for open (n = 56), 101 min for laparoscopic (n = 23), and 88 min for robotic (n = 70). There were no significant differences in times between open and laparoscopic repairs (p = 0.6); however, robotic repairs were quicker than both open (p = 0.012) and laparoscopic (p = 0.017) repairs. The cost for laparoscopic bilateral repair was higher compared to open ($19,727 vs $18,516, p = 0.014), but robotic surgery ($19,172) did not show a significant difference when compared to open (p = 0.11) or laparoscopic (p = 0.4) repairs.

CONCLUSIONS

Bilateral inguinal hernia repair is performed most quickly using robotic techniques and exhibits costs similar to those of open and laparoscopic surgery. Further studies exploring how surgeon experience with robotics affects costs and operative time are necessary.

Robot-assisted groin hernia repair is primarily performed by specialized surgeons: a scoping review

Surgical residents routinely participate in open and laparoscopic groin hernia repairs. The increasing popularity of robot-assisted groin hernia repair could lead to an educational loss for residents. We aimed to explore the involvement of surgical specialists and surgical residents, i.e., non-specialists, in robot-assisted groin hernia repair. The scoping review was reported according to PRISMA-ScR guideline. A protocol was uploaded at Open Science Framework, and a systematic search was conducted in four databases: PubMed, EMBASE, Cochrane CENTRAL, and Web of Science. Included studies had to report on robot-assisted groin hernia repairs. Data charting was conducted in duplicate. Of the 67 included studies, 85% of the studies described that the robot-assisted groin hernia repair was performed by a surgical specialist. The rest of the studies had no description of the primary operating surgeon. Only 13% of the included studies reported that a resident attended the robot-assisted groin hernia repair. Thus, robot-assisted groin hernia repair was mainly performed by surgical specialists, and robot-assisted groin hernia repair therefore seems to be underutilized to educate surgical residents.