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Surg Endosc. 2018 Dec;32(12):4850-4859. doi: 10.1007/s00464-018-6236-7. Epub 2018 May 15.

Robotic-assisted laparoscopic groin hernia repair: observational case-control study on the operative time during the learning curve.

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Department of Surgery, Maria Middelares, Buitenring Sint-Denijs 30, 9800, Ghent, Belgium.
Department of Surgery, Maria Middelares, Buitenring Sint-Denijs 30, 9800, Ghent, Belgium.
Center for Minimally Invasive and Robotic Surgery, Phoenix, AZ, USA.
Department of Surgery, Minneapolis VA Medical Center, University of Minnesota, Minneapolis, MN, USA.



Robotic groin hernia repair (r-TAPP) is demonstrating rapid adoption in the US. Barriers in Europe include: low availability of robotic systems to general surgeons, cost of robotic instruments, and the perception of longer operative time.


Patients undergoing r-TAPP in our start-up period were prospectively entered in the EuraHS database and compared to laparoscopic TAPP (l-TAPP) performed by the same surgeon within the context of two other prospective studies. Operations were performed with the daVinci Xi robot and the primary endpoint was skin-to-skin operative time.


Following proctoring in September 2016 by US surgeons, 50 r-TAPP (34 unilateral and 16 bilateral) procedures have been performed up to January 2017. Mean operative time for unilateral r-TAPP was 54 min, with a decrease from 63 min for the first tertile to 44 min for the third tertile. For unilateral l-TAPP, the mean operative time was 45 min. Mean operative time for bilateral r-TAPP was 78 min, with a decrease from 90 min for the first half to 68 min for the second half. For bilateral l-TAPP, the mean operative time was 61 min. There were no intraoperative complications and no conversions to conventional laparoscopy or open surgery. The operation was performed as an outpatient in 67% of cases. Urinary retention requiring urinary catheterization was the only early postoperative complication noted in 5 patients (10.2%). At 4 week follow-up, 7 patients (14.3%) had an asymptomatic seroma, but no other complications were seen.


Robotic TAPP was associated with a rapid reduction in operative time during our learning curve and afterwards the operative time to perform a robotic TAPP equals the operative time to perform a laparoscopic TAPP, both for unilateral and for bilateral groin hernia repairs. No complications related to the introduction of robotic-assisted laparoscopic groin hernia repair were observed.


Groin hernia; Inguinal hernia; Laparoscopy; Learning curve; Operative time; Robotic surgery


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