Comparative Outcomes of Laparoscopic Versus Robotic Surgery in Complex Hernia Repair: Implications for Perioperative Management, Critical Care, and Emergency Medicine — A Meta-analysis

Abstract

Robots are becoming more popular in undertaking complex ventral, incisional, and inguinal hernia repair but the relative effectiveness of the robot when compared to laparoscopic surgery continues to be controversial, especially as it relates to perioperative outcomes, use of resources, and systems-level implication. This systematic review and meta-analysis were performed based on PRISMA 2020 guidelines. Comparative studies with the publication dates between January 2011 and January 2026 were searched in MEDLINE, Embase, CENTRAL, and Web of Science. Randomized controlled trials and observational trials that compared robotic and laparoscopic hernia repair among adults were incorporated. The main outcomes were the operating time and the length of stay (LOS). The secondary outcomes were readmission, reoperation, surgical site infection (SSI), recurrence, and cost. Quantitative synthesis was done through random-effects models. There were fourteen studies that could qualify in terms of qualitative synthesis out of which ten studies were used in meta-analysis. Both ventral/incisional and inguinal repair showed a great deal of time-consuming operative time in robot repair. There were no statistically significant differences between pooled readmission approach, reoperation approach, or SSI approach. LOS reporting was heterogeneous, however, several propensities matched and registry-based analyses suggested shorter LOS and reduced downstream resource utilization with robotic repair. There were differences in the cost study findings, which found higher operative costs in randomized trials and similar or lower total episode-of-care costs in studies that used postoperative utilization. Robotic hernia repair is linked to increased operative time but shows similar short-term clinical results to laparoscopic repair and has the possibility of improving population outcomes in terms of LOS and resource consumption. These results point to the need to select the approach and consider the implications of perioperative, critical care, and emergency medicine.