Robotic Inguinal Hernia Repair: Helpful or Hurtful? 🤖

Robotic inguinal hernia repair is one of the fastest growing surgeries in the United States. Hospitals and surgeons are excited about it, but is it really the best choice for patients? A recent study and national discussions raise serious concerns about the long-term safety of robotic hernia repair¹.

Why Surgeons Like Robots

Doctors enjoy robotic surgery because the tools are high-tech, the view inside the belly is excellent, and movements are very precise. It also sounds modern and “minimally invasive.” In the short term, recovery looks about the same as open surgery^1-3.

The Hidden Problem: New Holes Mean New Hernias

To do robotic surgery, surgeons must make several holes in the belly wall for the camera and tools. These holes are often not closed tightly. Over time, these weak spots can turn into new hernias called trocar site hernias. This means patients may develop a brand-new hernia they never had before¹.

What the Research Shows 📊

A study followed 560 patients who had robotic hernia repair. After more than 5 years, about 1 in 4 patients (25%) developed another hernia. Most (18%) were trocar site hernias, but almost 10% were repeat groin hernias. At 7 years, the recurrence rate was nearly 9%¹. This is much higher than the recurrence rate seen with most open repairs^2,3.

Why This Is a Big Deal

Hernia surgery should solve the problem long-term. A 25% risk of another hernia is not acceptable. Open and laparoscopic repairs usually have much lower recurrence rates^2,4. Even worse, robotic surgery costs about twice as much without giving better results¹.

Better Options Exist ✅

Registry studies show that open preperitoneal repairs (TREPP/OPP) and Shouldice repairs often give better pain and recovery results than older methods like Lichtenstein^2,4,5. In fact, some studies show patients who had open posterior mesh repairs needed fewer pain medicines and had fewer complications³.

Should You Choose Robotic Repair?

While robotic repair sounds advanced, the evidence shows higher risks and higher costs. Open and laparoscopic repairs remain safer and more effective for most patients. If you’re considering hernia surgery, talk openly with your surgeon about every option—especially about long-term risks^1,6.

Bottom Line

Robotic hernia repair may look futuristic, but right now, the risks outweigh the benefits. For many patients, traditional approaches like open or laparoscopic hernia repair are the smarter choice.

References

1.SpringerLink. Robotic inguinal hernia repair article (featured study). Link.
2.Agarwal D, Bharani T, Fullington N, Ott L, Olson M, Poulose B, Warren J, Reinhorn M. Improved patient-reported outcomes after open preperitoneal inguinal hernia repair compared to anterior Lichtenstein repair: 10-year ACHQC analysis. Hernia 2023.
3.Reinhorn M, Fullington N, Agarwal D, Olson M, Ott L, Canavan A, Pate B, Hubertus M, Urquiza A, Poulose B, Warren J. Posterior mesh inguinal hernia repairs: laparoscopic and robotic versus open. Hernia 2022.
4.Bharani T, Agarwal D, Fullington N, Ott L, McClain D, Lima L, Poulose B, Warren J, Reinhorn M. Open preperitoneal repair vs Shouldice repair. Hernia 2023.
5.Ellis R, Melland-Smith M, Miller B, Petro C, Krpata D, Prabhu A, Ma J, Fullington N, Reinhorn M, Rosen M. Shouldice vs Lichtenstein: Registry-based comparison.

Author: Michael Reinhorn

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