A meta-analysis of clinical effects and safety of robotic inguinal hernia repair_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

HUANG Heng , LENG Bo ,  DIAO Wenji

Department General Surgery, Hernia and Abdominal Surgery, Affiliated Hospital of Traditional Chinese Medicine, Southwest Medical University, Luzhou, Sichuan 646000, P. R. China;

Corresponding author：

DIAO Wenji, Email: 806559958@qq.com

Keywords：

inguinal hernia; hernia repair; robot; meta-analysis

DOI：

10.7507/1007-9424.202104045

Video：

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Objective To systematically evaluate the clinical effect and safety of robotic inguinal hernia repair (robotic surgery).Methods The control studies on robotic surgery in treatment of inguinal hernia were searched in the English databases (PubMed, Cochrane Library, Embase) and Chinese databases (CNKI, Wanfang, VIP). The search time was from the establishment of the database to December 2020. After screening the literatures according to the inclusion and exclusion criteria, the Jadad scale was used to evaluate the literature quality of randomized controlled studies, the Newcastle-Ottawa scale (NOS) was used to evaluate the literature quality of the retrospective studies, and the RevMan5.3 software was used for meta-analysis.Results Twelve relevant articles with a total sample size of 7 661 cases that met the criteria were included in this study, including 1 746 cases of robotic inguinal hernia repair (robotic surgery), 4 361 cases of open inguinal hernia repair (open surgery), and 1 554 cases of laparoscopic inguinal hernia repair (laparoscopic surgery). The surgery time of the robotic surgery was longer than that of the traditional (including open and laparoscopic) surgery (P<0.01), open surgery (P<0.01) or laparoscopic surgery (P<0.01); The hospitalization cost of the robotic surgery was higher than that of traditional surgery (P<0.01) and open surgery (P<0.01). However, the readmission rate of the robotic surgery was lower than that of the traditional surgery (P<0.01) and open surgery (P<0.01). There were no significant differences in the other indicators between the robotic surgery and open surgery or laparoscopic surgery (P>0.05).Conclusion Robotic inguinal hernia repair is safe and feasible, which provides us a new way to treat inguinal hernia.

Citation： HUANG Heng, LENG Bo, DIAO Wenji. A meta-analysis of clinical effects and safety of robotic inguinal hernia repair. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2021, 28(12): 1625-1631. doi: 10.7507/1007-9424.202104045 Copy

1.	Köckerling F, Simons MP. Current concepts of inguinal hernia repair. Visc Med, 2018, 34(2): 145-150.
2.	Seetharamaiah R, Romero RJ, Kosanovic R, et al. Robotic repair of giant paraesophageal hernias. JSLS, 2013, 17(4): 570-577.
3.	田文, 郗洪庆. 机器人手术治疗食管裂孔疝价值及技术特点. 中国实用外科杂志, 2015, 35(11): 1169-1171.
4.	蒋会勇, 马锐, 郭一君, 等. 达芬奇机器人腹股沟疝十二例修补术. 中华疝和腹壁外科杂志(电子版), 2016, 10(5): 326-328.
5.	Galvani CA, Loebl H, Osuchukwu O, et al. Robotic-assisted paraesophageal hernia repair: initial experience at a single institution. J Laparoendosc Adv Surg Tech A, 2016, 26(4): 290-295.
6.	Sugiyama G, Chivukula S, Chung PJ, et al. Robot-assisted transabdominal preperitoneal ventral hernia repair. JSLS, 2015, 19(4): e2015.00092.
7.	Waite KE, Herman MA, Doyle PJ. Comparison of robotic versus laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair. J Robot Surg, 2016, 10(3): 239-244.
8.	Higgins RM, Frelich MJ, Bosler ME, et al. Cost analysis of robotic versus laparoscopic general surgery procedures. Surg Endosc, 2017, 31(1): 185-192.
9.	Kudsi OY, McCarty JC, Paluvoi N, et al. Transition from laparoscopic totally extraperitoneal inguinal hernia repair to robotic transabdominal preperitoneal inguinal hernia repair: a retrospective review of a single surgeon’s experience. World J Surg, 2017, 41(9): 2251-2257.
10.	Charles EJ, Mehaffey JH, Tache-Leon CA, et al. Inguinal hernia repair: is there a benefit to using the robot? Surg Endosc, 2018, 32(4): 2131-2136.
11.	Kolachalam R, Dickens E, D'Amico L, et al. Early outcomes of robotic-assisted inguinal hernia repair in obese patients: a multi-institutional, retrospective study. Surg Endosc, 2018, 32(1): 229-235.
12.	Kosturakis AK, LaRusso KE, Carroll ND, et al. First 100 consecutive robotic inguinal hernia repairs at a Veterans Affairs hospital. J Robot Surg, 2018, 12(4): 699-704.
13.	Gamagami R, Dickens E, Gonzalez A, et al. Open versus robotic-assisted transabdominal preperitoneal (R-TAPP) inguinal hernia repair: a multicenter matched analysis of clinical outcomes. Hernia, 2018, 22(5): 827-836.
14.	Muysoms F, Van Cleven S, Kyle-Leinhase I, et al. Robotic-assisted laparoscopic groin hernia repair: observational case-control study on the operative time during the learning curve. Surg Endosc, 2018, 32(12): 4850-4859.
15.	Huerta S, Timmerman C, Argo M, et al. Open, laparoscopic, and robotic inguinal hernia repair: outcomes and predictors of complications. J Surg Res, 2019, 241: 119-127.
16.	Pokala B, Armijo PR, Flores L, et al. Minimally invasive inguinal hernia repair is superior to open: a national database review. Hernia, 2019, 23(3): 593-599.
17.	Zayan NE, Meara MP, Schwartz JS, et al. A direct comparison of robotic and laparoscopic hernia repair: patient-reported outcomes and cost analysis. Hernia, 2019, 23(6): 1115-1121.
18.	Olavarria OA, Bernardi K, Shah SK, et al. Robotic versus laparoscopic ventral hernia repair: multicenter, blinded randomized controlled trial. BMJ, 2020, 370: m2457.
19.	HerniaSurge Group. International guidelines for groin hernia management. Hernia, 2018, 22(1): 1-165.
20.	Rosenberg J, Bisgaard T, Kehlet H, et al. Danish Hernia Database recommendations for the management of inguinal and femoral hernia in adults. Dan Med Bull, 2011, 58(2): C4243.
21.	Campanelli G, Bruni PG, Morlacchi A, et al. Primary inguinal hernia: the open repair today pros and cons. Asian J Endosc Surg, 2017, 10(3): 236-243.
22.	Tam V, Rogers DE, Al-Abbas A, et al. Robotic inguinal hernia repair: a large health system’s experience with the first 300 cases and review of the literature. J Surg Res, 2019, 235: 98-104.
23.	Escobar Dominguez JE, Ramos MG, Seetharamaiah R, et al. Feasibility of robotic inguinal hernia repair, a single-institution experience. Surg Endosc, 2016, 30(9): 4042-4048.
24.	刘竞, 智迎辉, 肖海涛, 等. 机器人辅助腹腔镜经腹膜前间隙腹股沟疝修补术的临床分析. 中华医学杂志, 2020, 100(36): 2858-2860.
25.	Economopoulos KP, Mylonas KS, Stamou AA, et al. Laparoscopic versus robotic adrenalectomy: a comprehensive meta-analysis. Int J Surg, 2017, 38: 95-104.
26.	Zhang W, Huang Z, Zhang J, et al. Safety and efficacy of robot-assisted versus open pancreaticoduodenectomy: a meta-analysis of multiple worldwide centers. Updates Surg, 2021, 73(3): 893-907.
27.	Qabbani A, Aboumarzouk OM, ElBakry T, et al. Robotic inguinal hernia repair: systematic review and meta-analysis. ANZ J Surg, 2021, Jan 21. Online ahead of print.
28.	Li K, Zou J, Tang J, et al. Robotic versus laparoscopic bariatric surgery: a systematic review and meta-analysis. Obes Surg, 2016, 26(12): 3031-3044.
29.	田文, 费阳. 达芬奇手术机器人系统在疝外科的应用. 中华胃肠外科杂志, 2018, 21(7): 740-743.
30.	贾卓奇, 周维茹, 陈南征, 等. 达芬奇机器人食管裂孔疝修补术临床疗效分析. 中华胃食管反流病电子杂志, 2020, 7(2): 71-76.
31.	Washington K, Watkins JR, Jeyarajah DR. The first year is the hardest: a comparison of early versus late experience after the introduction of robotic hiatal hernia repair. J Robot Surg, 2020, 14(1): 205-210.
32.	Chen S, Chen JZ, Zhan Q, et al. Robot-assisted laparoscopic versus open pancreaticoduodenectomy: a prospective, matched, mid-term follow-up study. Surg Endosc, 2015, 29(12): 3698-3711.
33.	Shi Y, Jin J, Qiu W, et al. Short-term outcomes after robot-assisted vs open pancreaticoduodenectomy after the learning curve. JAMA Surg, 2020, 155(5): 389-394.

1. Köckerling F, Simons MP. Current concepts of inguinal hernia repair. Visc Med, 2018, 34(2): 145-150.
2. Seetharamaiah R, Romero RJ, Kosanovic R, et al. Robotic repair of giant paraesophageal hernias. JSLS, 2013, 17(4): 570-577.
3. 田文, 郗洪庆. 机器人手术治疗食管裂孔疝价值及技术特点. 中国实用外科杂志, 2015, 35(11): 1169-1171.
4. 蒋会勇, 马锐, 郭一君, 等. 达芬奇机器人腹股沟疝十二例修补术. 中华疝和腹壁外科杂志(电子版), 2016, 10(5): 326-328.
5. Galvani CA, Loebl H, Osuchukwu O, et al. Robotic-assisted paraesophageal hernia repair: initial experience at a single institution. J Laparoendosc Adv Surg Tech A, 2016, 26(4): 290-295.
6. Sugiyama G, Chivukula S, Chung PJ, et al. Robot-assisted transabdominal preperitoneal ventral hernia repair. JSLS, 2015, 19(4): e2015.00092.
7. Waite KE, Herman MA, Doyle PJ. Comparison of robotic versus laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair. J Robot Surg, 2016, 10(3): 239-244.
8. Higgins RM, Frelich MJ, Bosler ME, et al. Cost analysis of robotic versus laparoscopic general surgery procedures. Surg Endosc, 2017, 31(1): 185-192.
9. Kudsi OY, McCarty JC, Paluvoi N, et al. Transition from laparoscopic totally extraperitoneal inguinal hernia repair to robotic transabdominal preperitoneal inguinal hernia repair: a retrospective review of a single surgeon’s experience. World J Surg, 2017, 41(9): 2251-2257.
10. Charles EJ, Mehaffey JH, Tache-Leon CA, et al. Inguinal hernia repair: is there a benefit to using the robot? Surg Endosc, 2018, 32(4): 2131-2136.
11. Kolachalam R, Dickens E, D'Amico L, et al. Early outcomes of robotic-assisted inguinal hernia repair in obese patients: a multi-institutional, retrospective study. Surg Endosc, 2018, 32(1): 229-235.
12. Kosturakis AK, LaRusso KE, Carroll ND, et al. First 100 consecutive robotic inguinal hernia repairs at a Veterans Affairs hospital. J Robot Surg, 2018, 12(4): 699-704.
13. Gamagami R, Dickens E, Gonzalez A, et al. Open versus robotic-assisted transabdominal preperitoneal (R-TAPP) inguinal hernia repair: a multicenter matched analysis of clinical outcomes. Hernia, 2018, 22(5): 827-836.
14. Muysoms F, Van Cleven S, Kyle-Leinhase I, et al. Robotic-assisted laparoscopic groin hernia repair: observational case-control study on the operative time during the learning curve. Surg Endosc, 2018, 32(12): 4850-4859.
15. Huerta S, Timmerman C, Argo M, et al. Open, laparoscopic, and robotic inguinal hernia repair: outcomes and predictors of complications. J Surg Res, 2019, 241: 119-127.
16. Pokala B, Armijo PR, Flores L, et al. Minimally invasive inguinal hernia repair is superior to open: a national database review. Hernia, 2019, 23(3): 593-599.
17. Zayan NE, Meara MP, Schwartz JS, et al. A direct comparison of robotic and laparoscopic hernia repair: patient-reported outcomes and cost analysis. Hernia, 2019, 23(6): 1115-1121.
18. Olavarria OA, Bernardi K, Shah SK, et al. Robotic versus laparoscopic ventral hernia repair: multicenter, blinded randomized controlled trial. BMJ, 2020, 370: m2457.
19. HerniaSurge Group. International guidelines for groin hernia management. Hernia, 2018, 22(1): 1-165.
20. Rosenberg J, Bisgaard T, Kehlet H, et al. Danish Hernia Database recommendations for the management of inguinal and femoral hernia in adults. Dan Med Bull, 2011, 58(2): C4243.
21. Campanelli G, Bruni PG, Morlacchi A, et al. Primary inguinal hernia: the open repair today pros and cons. Asian J Endosc Surg, 2017, 10(3): 236-243.
22. Tam V, Rogers DE, Al-Abbas A, et al. Robotic inguinal hernia repair: a large health system’s experience with the first 300 cases and review of the literature. J Surg Res, 2019, 235: 98-104.
23. Escobar Dominguez JE, Ramos MG, Seetharamaiah R, et al. Feasibility of robotic inguinal hernia repair, a single-institution experience. Surg Endosc, 2016, 30(9): 4042-4048.
24. 刘竞, 智迎辉, 肖海涛, 等. 机器人辅助腹腔镜经腹膜前间隙腹股沟疝修补术的临床分析. 中华医学杂志, 2020, 100(36): 2858-2860.
25. Economopoulos KP, Mylonas KS, Stamou AA, et al. Laparoscopic versus robotic adrenalectomy: a comprehensive meta-analysis. Int J Surg, 2017, 38: 95-104.
26. Zhang W, Huang Z, Zhang J, et al. Safety and efficacy of robot-assisted versus open pancreaticoduodenectomy: a meta-analysis of multiple worldwide centers. Updates Surg, 2021, 73(3): 893-907.
27. Qabbani A, Aboumarzouk OM, ElBakry T, et al. Robotic inguinal hernia repair: systematic review and meta-analysis. ANZ J Surg, 2021, Jan 21. Online ahead of print.
28. Li K, Zou J, Tang J, et al. Robotic versus laparoscopic bariatric surgery: a systematic review and meta-analysis. Obes Surg, 2016, 26(12): 3031-3044.
29. 田文, 费阳. 达芬奇手术机器人系统在疝外科的应用. 中华胃肠外科杂志, 2018, 21(7): 740-743.
30. 贾卓奇, 周维茹, 陈南征, 等. 达芬奇机器人食管裂孔疝修补术临床疗效分析. 中华胃食管反流病电子杂志, 2020, 7(2): 71-76.
31. Washington K, Watkins JR, Jeyarajah DR. The first year is the hardest: a comparison of early versus late experience after the introduction of robotic hiatal hernia repair. J Robot Surg, 2020, 14(1): 205-210.
32. Chen S, Chen JZ, Zhan Q, et al. Robot-assisted laparoscopic versus open pancreaticoduodenectomy: a prospective, matched, mid-term follow-up study. Surg Endosc, 2015, 29(12): 3698-3711.
33. Shi Y, Jin J, Qiu W, et al. Short-term outcomes after robot-assisted vs open pancreaticoduodenectomy after the learning curve. JAMA Surg, 2020, 155(5): 389-394.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

A meta-analysis of clinical effects and safety of robotic inguinal hernia repair

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