The Efficacy and Safety of Robotic Vs Laparoscopic Inguinal Hernia Repair, a Systematic Review and Meta-analysis

Background: Surgical robots operations is an emerging technology that offers many advantages in conducting complex endoscopic procedures. However, robot-assisted inguinal hernia repair generates controversies compared to laparoscopic inguinal hernia repair. We evaluated the safety and efficiency of robot-assisted inguinal hernia repair compared to the laparoscopic. Methods: The Pub Med, EMBASE, and Cochrane Library databases was carried out to obtain studies that comparatively evaluated the efficacy, safety, and the economy between robot-assisted and laparoscopic inguinal hernia repair. Rev man software was used to analyze the data according to random effects models. Results: Six studies, of 3246 patients were included, 1025 patients underwent robot-assisted and 2221patients underwent laparoscopic surgery. The review showed that robotic-assisted inguinal hernia may reduce the pain compared with laparoscopic, while hospitals cost was significantly higher in robotic surgery than laparoscopic. There was no significant difference between robotic and laparoscopic surgery in decreasing surgical site infection (OR=4.08, 95%CI: 0.39-43.02, P=0.24), hospital length (MD=0.03, 95%CI: 0.04-0.10, P=0.34), the incidence of hematoma (OR=1.38, 95%CI: 0.57-3.37, P=0.48), seroma (OR=1.15, 95%CI: 0.61-2.15, P=0.67), urinary retention (OR=1.42, 95%CI: 0.67-2.97, P=0.36), and complication (OR=1.158, 95%CI:0.87- 2.87, P=0.14). Conclusions: This study showed robotic-assisted inguinal hernia might reduce pain compared with the laparoscopic group but incurred higher costs. There was no significant difference between robotic and laparoscopic surgery in other efficacy and safety outcomes, which im plying that robotic surgery could be an alternative procedure to laparoscopic instead of replacement in inguinal hernia repair. More robust and high-value randomized trials are required to determine the safety and efficacy of robot-assisted inguinal hernia repair.