Robotic versus laparoscopic intraperitoneal onlay mesh (IPOM) repair for ventral hernia: a GRADE-assessed systematic review and meta-analysis of randomized controlled trials on operative time, postoperative complications, and 12-24-month recurrence.

Abstract

<h4>Background</h4>Minimally invasive ventral hernia repair has evolved significantly with the introduction of robotic assistance, yet whether robotic-assisted intraperitoneal onlay mesh (IPOM) repair offers clinical advantages over conventional laparoscopic IPOM remains unclear. While robotic platforms provide enhanced dexterity, three-dimensional visualization, and improved ergonomics, these theoretical benefits must be balanced against longer operative times and substantially higher costs. This systematic review and meta-analysis aimed to compare the safety, efficacy, and clinical outcomes of robotic versus laparoscopic IPOM repair for ventral hernias.<h4>Methods</h4>This systematic review and meta-analysis were prospectively registered in PROSPERO (CRD ID: CRD420251146940). We searched multiple databases, MEDLINE (PubMed), Embase (Ovid), Cochrane CENTRAL, Scopus, Web of Science, ClinicalTrials.gov, WHO ICTRP, and Google Scholar from inception to 8th September 2025 for randomized controlled trials comparing robotic versus laparoscopic IPOM repair in adults with primary or incisional ventral hernias. Risk of bias was assessed using the RoB 2 tool, and evidence certainty was evaluated using the GRADE methodology. Random-effects meta-analyses were performed using Review Manager.<h4>Results</h4>Three randomized controlled trials comprising 236 patients (122 robotic, 114 laparoscopic) were included. Robotic repair was associated with significantly longer operative time (mean difference: 62.60 min, 95% CI: 50.23-74.98, p < 0.00001, moderate certainty evidence). No significant differences were observed in overall postoperative complications (OR: 1.13, 95% CI: 0.54-2.36, low certainty due to imprecision and small study effects), length of hospital stay (mean difference: -0.02 days, 95% CI: -0.32 to 0.27, low certainty), readmission rates (OR: 0.46, 95% CI: 0.08-2.70, very low ), reoperation rates (OR: 0.30, 95% CI: 0.03-2.92, very low ), conversion to open surgery (OR: 0.91, 95% CI: 0.22-3.83, low certainty), or hernia recurrence at 12-24 months follow-up (OR: 0.97, 95% CI: 0.26-3.63, low certainty).<h4>Conclusion</h4>Current randomized evidence demonstrates that robotic IPOM repair requires longer operative time than laparoscopic repair but shows no significant differences in short-term safety outcomes or long-term efficacy. Larger, high-quality randomized trials are needed to establish definitive recommendations.