Robotic versus Laparoscopic Ventral Hernia Repair

Two-year Results from a Prospective, Multicenter, Blinded Randomized Clinical Trial

Abstract

Objective: 

Report the two-year outcomes of a multi-center randomized controlled trial comparing robotic versus laparoscopic intraperitoneal onlay mesh ventral hernia repair.

Summary Background Data: 

Ventral hernia repair is one of the most common operations performed by general surgeons. To our knowledge, no studies have been published to date comparing long-term outcomes of laparoscopic versus robotic ventral hernia repair.

Methods: 

The trial was registered at clinicaltrials.gov (NCT03490266). Clinical outcomes included surgical site infection, surgical site occurrence, hernia occurrence, readmission, reoperation, and mortality.

Results: 

175 consecutive patients were approached that were deemed eligible for elective minimally invasive ventral hernia repair. 124 were randomized and 101 completed follow-up at two years. Two-year follow-up was completed in fifty-four patients (83%) in the robotic arm and 47 patients (80%) in the laparoscopic arm. No differences were seen in surgical site infection or surgical site occurrence. Hernia recurrence occurred in two patients (4%) receiving robotic repair versus in six patients (13%) receiving laparoscopic repair (relative risk 0.3, 95% confidence interval 0.06 to 1.39; P=0.12). No patients (0%) required reoperation in the robotic arm whereas five patients (11%) underwent reoperation in the laparoscopic arm (P=0.019, relative risk not calculatable due to null outcome).

Conclusions: 

Robotic ventral hernia repair demonstrated at least similar if not improved outcomes at two-years compared to laparoscopy. There is potential benefit with robotic repair, however additional multi-center trials and longer follow-up are needed to validate the hypothesis-generating findings of this study.