Robotic Transabdominal Preperitoneal Inguinal Hernia Repair Is Feasible and Efficient: A Prospective Cohort Study of a Day-Only Protocol From a High-Volume Robotic Surgery Centre Evaluating Short-Term Outcomes.

Abstract

<h4>Background</h4>Inguinal hernia repair (IHR) is one of the most frequently performed procedures in general surgery. There is clinical equipoise regarding the increasing global adoption of robotic IHR as a safe minimally invasive option. We present the short-term outcomes of robotic transabdominal (R-TAPP) preperitoneal IHR as a protocol-driven day-only procedure within a high-volume centre.<h4>Methods</h4>Single institution prospective cohort study of 200 consecutive patients using the da Vinci Xi system from July 2023 to April 2025. Elective adult patients with index or recurrent unilateral or bilateral inguinal hernias were eligible. Postoperative day (POD) 1.7 and 28 pain scores and analgesia use were recorded. Thirty-day operative complications were tabulated.<h4>Results</h4>Eighty-nine percent were male and 66% underwent unilateral R-TAPP IHR. Six percent had redo surgery for recurrent inguinal hernia. For unilateral IHR, the median console time was 29 min (IQR: 21-39.5), knife to skin and skin closure time was 49 min (IQR: 37-59.5) and total time into and out (wheels in to wheels out) of theatre was 77 min (IQR: 66.5-88.5). The median length of stay was 0 days (range: 0-2). Median POD 1.7 and 28 pain scores were 4, 2, and 0 (out of 10). Clavien-Dindo 1-2 complications occurred in 4%. There were no hernia recurrences.<h4>Conclusions</h4>R-TAPP IHR is feasible and safe, with comparatively lower operative time than the reported literature. Most patients were discharged as a day-only procedure, with minimal postoperative pain. Future studies will investigate the cost and longer-term outcomes.