Traditional Laparoscopic Ventral Hernia Repair Preferred Over Robotic Approach

Robotic and laparoscopic ventral hernia repair were found to have no significant differences in postoperative pain, complications, quality of life, and length of hospital stay; however, the increased operative time and cost associated with the robotic platform justify laparoscopic repair as the preferred approach. These findings were published in JAMA Surgery.

The registry-based randomized controlled trial (ClinicalTrials.gov Identifier: NCT03283982) enrolled patients at the Cleveland Clinic Center for Abdominal Core Health between September 2017 and January 2020. The study population included 75 adults with primary or incisional midline ventral hernias (£7 cm) who were randomly assigned to receive robotic (n=39) or laparoscopic (n=36) ventral hernia repair. Patients were assessed for clinical outcomes for up to 1 year.

At baseline, the 2 cohorts were well balanced for demographics, excluding median body mass index, which was elevated in the robotic repair group (35; interquartile range [IQR], 31-39 kg/m²) compared with the laparoscopic group (31; IQR, 27-36 kg/m²; P =.02).

“All patients achieved fascial closure and mesh placement with adequate overlap adhering to the study protocol,” the study authors said. Two patients in the robotic repair cohort received the laparoscopic modality instead. One of these instances was due to a malfunction with the robotic machinery; the other was attributed to a lack of intraperitoneal space to support intracorporeal structuring.

The rate of transfascial suture and permanent track fixation was 100% in the laparoscopic repair cohort vs 6% in the robotic repair cohort (P <.001). The median operative time was found to be longer with the robotic method, which required an average of 146 minutes (IQR, 123-192 minutes; P <.001). The median operative time with the laparoscopic approach was 94 minutes (IQR, 69-116 minutes; P <.001). The robotically facilitated repairs were therefore more costly (total cost ratio, 1.13 vs 0.97; P =.03).

Post-procedure, patients assigned to laparoscopic or robotic repair had similar median durations of hospital stay (10 days vs 25 days; P =.17), morphine equivalents (45 vs 46; P =.88), complications (8% vs 6%; P >.99), and rates of same-day discharge (56% vs 44%; P =.42), respectively.

The Patient-Reported Outcomes Measurement Information System (PROMIS) 3a pain scores were similar when assessed preoperatively and at 30 days postoperatively. However, patients in the laparoscopic cohort demonstrated “statistically significant improvement,” (-3 vs 0; P =.03), the investigators said.

The study was limited by a lack of long-term follow-up data “to elucidate the durability of each repair technique” and prolonged pain benefit, according to the study authors. “Laparoscopic and robotic ventral hernia repair with intraperitoneal mesh offer similar early postoperative outcomes in regards to pain, [quality of life], and complication rates. Owing to the increased operative time and associated cost, there is currently no measurable benefit to justify the robotic approach,” they concluded.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of the authors’ disclosures.

Reference

Petro CC, Zolin S, Krpata D, et al. Patient-Reported Outcomes of Robotic vs Laparoscopic Ventral Hernia Repair With Intraperitoneal Mesh The PROVE-IT Randomized Clinical Trial. JAMA Surg. Published online October 21, 2020. doi:10.1001/jamasurg.2020.4569