Long-term outcomes of robotic inguinal hernia repair (r-TAPP): a retrospective review of 434 consecutive cases by a single surgeon with 3-8 years of follow-up.

Abstract

When evaluating the long-term follow-up of robotic-assisted transabdominal preperitoneal (r-TAPP) approach to inguinal hernias, research remains limited due to small patient cohorts and shorter follow-up durations. The most significant research on inguinal hernia repair utilizing r-TAPP procedure includes follow-up periods of up to 2 years and examines approximately 150 cases. This article presents data from 434 consecutive r-TAPP procedures conducted on 324 patients, with follow-up ranging from a minimum of 3 years to 8 years. These procedures were performed between April 2016 and February 2021. Patients were seen in person for a follow-up appointment 2 weeks after surgery, with additional follow-ups conducted via phone at half a year, a full year, and yearly thereafter up to 8 years. Among the 324 patients, 107 patients presented with left-sided inguinal hernias (33%), 107 presented with right-sided inguinal hernias (33%), and 110 presented with bilateral inguinal hernias (33.95%). Patients' ages varied between 25 and 96 years, and their BMI ranged from 17.7 to 50.2 (mean: 26.9, median: 26.2). Total procedure time varied from 35 to 191 min (mean: 62 min, median: 54 min). Within this, the docking time averaged 6 min, ranging from 3 to 15 min. The console time, which constitutes the primary operative phase, averaged 43 min, with a range of 11-183 min. The ASA scores varied between 1 and 3 (mean: 2, median: 2). None of the 324 patients experienced major blood loss, required conversion to open surgery, or had to stay overnight; every patient was sent home on the day of the procedure. Follow-up rates included 86.9% at 3 years, 87.1% at 4 years, 86.7% at 5 years, 86.4% at 6 years, 89.7% at 7 years, and 87.5% at 8 years. Two hernia recurrences were reported out of the 324 patients with 434 hernias performed, and no patients reported chronic pain between 3 and 8 years post-operation. The r-TAPP procedure provides a secure and efficient repair with a low recurrence rate (0.46%), reduced chronic pain, and competitive operative times. Compared to laparoscopic repair, which has a median operative time of 79 min, r-TAPP showed average times of 54 min for left-lateral hernias, 53 min for right-lateral hernias, and 79 min for bilateral cases (Kakiashvili et al.). While slightly longer than open repair (median time of 44 min), with differences of about 10 min for unilateral and 35 min for bilateral cases, r-TAPP offers superior precision and outcomes, making it a valuable option for inguinal hernia repair.