Should Surgeons Really Switch to Robotic-Assisted Groin Hernia Repair?
- Carlos E Costa Almeida
- há 3 horas
- 3 min de leitura
Robotic-assisted groin hernia repair is now available in many hospitals worldwide. Proponents of its widespread adoption argue that it is associated with better outcomes, fewer complications, and faster postoperative recovery compared with conventional laparoscopic techniques. However, robotic surgery is, in essence, a laparoscopic approach. The main difference is that the surgeon uses a robotic platform to assist and enhance surgical movements, potentially increasing precision and safety. Whether this translates into improved outcomes and faster recovery remains an open question.
When laparoscopic surgery was introduced for hernia repair, substantial advantages for patients—particularly in terms of postoperative pain and recovery—became evident. It is now widely accepted that laparoscopic groin hernia repair is associated with less postoperative pain and a faster, easier recovery. Patients who have undergone both open and laparoscopic repairs often confirm this perception. Based on this experience, transabdominal preperitoneal repair (TAPP) is the approach I most commonly choose, as it is clearly better for patients.
Does robotic-assisted repair offer an even faster recovery with less pain?
A direct comparison between laparoscopic and robotic-assisted groin hernia repair is therefore warranted. In this context, Dr. Fiorenzo V. Angehrn et al. from Switzerland published a study in BJS in 2026 comparing laparoscopic totally extraperitoneal repair (TEP) with robotic transabdominal preperitoneal repair (rTAPP). The study aimed to evaluate and compare postoperative pain between the two techniques. However, I believe that rTAPP should have been compared with TAPP, as TEP and TAPP are not equivalent procedures. This represents a potential limitation of the study. As the authors themselves acknowledge, rTAPP involves opening the peritoneum and closing it with absorbable sutures—steps that could theoretically influence postoperative pain.
The study included 182 patients undergoing elective groin hernia repair: 91 were randomized to TEP and 91 to rTAPP. The rTAPP group had a higher proportion of bilateral hernias and a greater number of type III hernias (>3 cm). The authors found no significant differences in postoperative pain during coughing, as measured by the NRS, at 2 hours (p = 0.558), 24 hours (p = 0.431), and 7 days (p = 0.074) after surgery. Operative time was significantly longer in the rTAPP group for both unilateral and bilateral hernia repairs (p < 0.001 and p = 0.002, respectively).
Complication rates were similar between the two groups (p > 0.999). There were no recurrences in the rTAPP group and one recurrence at 12 months in the TEP group; however, this difference was not statistically significant (p > 0.999). The rate of day-case surgery was comparable between groups. As expected, rTAPP “required less physical and mental effort for the surgeon”, but was associated with longer operative times and higher costs. Additionally, no differences in postoperative quality of life were observed between the two techniques.
According to Dr. Fiorenzo et al., these results are consistent with other studies, including randomized controlled trials comparing TAPP with rTAPP. An important point to consider is the higher proportion of large hernias (>3 cm) in the rTAPP group, which may partly explain the longer operative times. Based on these findings, it is difficult to advocate the routine use of robotic-assisted groin hernia repair over laparoscopic TEP. Although rTAPP reduced the surgeons’ workload, this did not translate into meaningful benefits for patients. Achieving comparable outcomes at the expense of longer operative times and higher costs is difficult to justify. In this context, the authors conclude their publication by stating that the “widespread adoption of rTAPP remains debatable in light of these findings.”
This is not to suggest that robotic-assisted surgery for groin hernia repair is an inferior option; rather, as surgeons and physicians, we must occasionally pause and think critically, without allowing technological fascination to cloud our judgment.
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Dr. Carlos Eduardo Costa Almeida
General Surgeon
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