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HOW HAS ROBOTICS CHANGED OUR APPROACH TO INGUINAL HERNIA REPAIR?
William T. Head
*, Divyaam Satija, Stefanie C. Rohde, Dylan S. Goto, Sidhant Kalsotra, Savannah Renshaw, Patrick Sweigert, Courtney Collins, Benjamin Poulose
Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
IntroductionRobotic-assisted surgery has transformed hernia management; however, its utilization compared to other approaches remains unknown. This study aims to quantify the utilization trends for robotic, laparoscopic, and open surgery in inguinal hernia repair (IHR).
MethodsA retrospective cohort study was conducted using the Abdominal Core Health Quality Collaborative (ACHQC), an international data registry with long-term follow-up related to hernia repairs. All patients that underwent IHR from 2016-2023 were evaluated. Patients were categorized by IHR timing (Initial vs Recurrent) as well as approach (Open vs MIS – laparoscopic or robotic). Spearman’s rank test was used to evaluate temporal trends. Demographics and outcomes data were compared with Chi-Squared and Mann-Whitney U tests for categorical and continuous variables, respectively.
Results2766 patients underwent Initial IHR (1777 Open vs 989 MIS), and 294 underwent Recurrent IHR (142 Open vs 152 MIS). The Initial groups as well as the Recurrent groups were clinically comparable with respect to age, sex, race, BMI, and ASA class. Outcomes were significantly comparable for surgical site infection within 30 days, recurrence and reoperation within 30 days and 2 years, and patient reported outcome measures at 30 days and 2 years. Notable differences included MIS approaches requiring >2 hours almost twice as often for initial IHR (MIS >2 hours 46.5% vs Open 24.7%; p<0.001) and open approach having more surgical site occurrences within 30 days for recurrent IHR (MIS 4 [3.3%] vs Open 14 [12.4%]; p=0.019). When comparing utilization trends for initial IHR, open decreased by 20.2% across the study period while MIS increased by 20.2% (p<0.05). This increase was overwhelmingly driven by robotics. Recurrent IHR also saw a significant shift. Initially, 57.9% were performed open compared to 42.1% MIS. An inflection was observed between 2020-2021 with the majority then being performed via MIS approaches – largely robotic (83.3%). Notably, Spearman’s rank test confirmed that MIS approaches were strongly correlated with year while open approach was inversely correlated for both initial (|rho| = 0.89; p=0.012) and recurrent IHR (|rho| = 0.96; p=0.002).
ConclusionThis is the first quantitative analysis of IHR approaches over time in the context of initial and recurrent hernias. A significant shift in surgical approach was observed with robotic techniques far outpacing both open and laparoscopic approaches for initial and recurrent IHR. With a marked decrease in utilization of the open approach for recurrent inguinal hernias, renewed evaluation to determine the safest and most durable approach and the training necessary for this challenging population should be further explored.
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