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Robotic-assisted and laparoscopic hernia repair: real-world evidence from the Americas Hernia Society Quality Collaborative (AHSQC)

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Abstract

Background

Ventral hernia repair (VHR) is a commonly performed procedure and is especially prevalent in patients who have undergone previous open abdominal surgery: up to 28% of patients who have undergone laparotomy will develop a ventral hernia. There is increasing interest in robotic-assisted VHR (RVHR) as a minimally invasive approach to VHR not requiring myofascial release and in RVHR outcomes relative to outcomes associated with laparoscopic VHR (LVHR). We hypothesized real-world evidence from the Americas Hernia Society Quality Collaborative (AHSQC) database will indicate comparable clinical outcomes from RVHR and LVHR approaches not employing myofascial release.

Methods

Retrospective, comparative analysis of prospectively collected data describing laparoscopic and robotic-assisted elective ventral hernia repair procedures reported in the multi-institutional AHSQC database. A one-to-one propensity score matching algorithm identified comparable groups of patients to adjust for potential selection bias that could result from surgeon choice of repair approach.

Results

Matched data describe preoperative characteristics and perioperative outcomes in 615 patients in each group. The following significant differences were observed among the 11 outcomes that were pre-specified. Operative time tended to be longer for the RVHR group compared to the LVHR group (p < 0.001). Length of stay differed between the two groups; while both groups had a median length of stay of 0, stay lengths tended to be longer in the LVHR group (p < 0.001). Rates of conversion to laparotomy were fewer for the RVHR group: < 1% and 2%, respectively (p = 0.007). Through 30 days, there were fewer RVHR patient-clinic visits (p = 0.038).

Conclusion

Both RVHR and LVHR perioperative results compare favorably with each other in most measures. Differences favored RVHR in terms of shorter LOS, fewer conversions to laparotomy, and fewer postoperative clinic visits; differences favored LVHR in terms of shorter operative times.

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Acknowledgments

The authors thank the participating ASHQC surgeons for their contributions and to Mimi Wainwright for medical writing support.

Funding

Intuitive Surgical funded independent editorial support and data analysis; the data analysis methodology were prespecified and performed by AHSQC. The Americas Hernia Society Quality Collaborative Foundation (AHSQC Foundation) and its Americas Hernia Society Quality Collaborative (AHSQC) and the hospitals and surgeons participating in the AHSQC are the source of the data and AHSQC Foundation is the source of the data analysis reproduced in Tables and Figures used in this manuscript. AHSQC Foundation and the participants in the AHSQC: (i) have not verified, are not responsible for, and do not endorse the selection of data or the research questions, hypotheses, conclusions, calls for further study or any other matter (except for the data and its analysis prepared by AHSQC Foundation apart from this manuscript) presented in this manuscript and (ii) do not endorse any product, service, or technique referred to or analyzed in this manuscript. All Tables and Figures are used with permission of Americas Hernia Society Quality Collaborative Foundation and are its copyright works. Copyright 2017 Americas Hernia Society Quality Collaborative Foundation. All rights reserved.

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Authors and Affiliations

  1. University Health Systems, University of Tennessee Medical Center, 1934 Alcoa Highway, Suite D-285, Knoxville, TN, 37920, USA

    Melissa LaPinska, Kyle Kleppe & Lars Webb

  2. Department of Surgery, University of Tennessee Graduate School of Medicine, Knoxville, TN, USA

    Melissa LaPinska, Kyle Kleppe & Lars Webb

  3. Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA

    Thomas G. Stewart

  4. Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY, USA

    Molly Olson

Authors
  1. Melissa LaPinska
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  2. Kyle Kleppe
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Corresponding author

Correspondence to Melissa LaPinska.

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Disclosures

Dr. LaPinska reports personal fees from Intuitive Surgical, personal fees from Allergan / LifeCell, personal fees from Symmetry Surgical, outside the submitted work. Ms. Olson reports indirect financial support from AHSQC, outside the submitted work. Dr. Stewart reports indirect financial support from AHSQC, during the conduct of the study. Dr. Kleppe and Dr. Webb have nothing to disclose.

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LaPinska, M., Kleppe, K., Webb, L. et al. Robotic-assisted and laparoscopic hernia repair: real-world evidence from the Americas Hernia Society Quality Collaborative (AHSQC). Surg Endosc 35, 1331–1341 (2021). https://doi.org/10.1007/s00464-020-07511-w

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  • DOI: https://doi.org/10.1007/s00464-020-07511-w

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