Shorter operative times following robotic-assisted transabdominal preperitoneal inguinal hernia repair (TAPP) compared to laparoscopic TAPP: the Danish Inguinal Randomized Controlled Trial (DIRECT).

Abstract

<h4>Background</h4>Despite the perception of higher procedural costs and longer operative time, robotic-assisted inguinal hernia repair has emerged as an alternative to the laparoscopic procedure. The present study was conducted to determine the time required for robotic and laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair and to determine whether these time profiles differ between the two groups.<h4>Method</h4>One hundred thirty-eight patients were randomized to a robotic-assisted r-TAPP (n = 74; 54%) or a laparoscopic l-TAPP (n = 64; 46%) procedure by experienced surgeons. The hernia defect was classified as either simple or complicated according to hernia size, involvement of the scrotum, and whether the hernia was a primary defect, a recurrence, or a bilateral defect.<h4>Results</h4>Time from intubation to skin closure (P < 0.05) and from air insufflation to removal of instruments (P < 0.05) were shorter for the r-TAPP than for the l-TAPP procedure. This difference was observed for both simple and complex hernias, the difference between groups being larger for the complicated than for the simple defects. The analysis demonstrated that an additional 5 min were needed to dock the robotic platform and place the instruments. Despite this delay, the time required for the procedure remained shorter for the r-TAPP than for the l-TAPP repair.<h4>Conclusion</h4>Robotic-assisted inguinal hernia repair is associated with a shorter operative time than conventional laparoscopy. While the time required for docking and instrument placement caused a minor delay of the procedure, the operating time for the robotic repair was shorter than for the laparoscopic procedure.