Robotic versus open transversus abdominis release and incisional hernia repair: A case-control study

Abstract

Objective: Transversus abdominus release (TAR) is often required to achieve apposition of the rectus muscles and achieve wide mesh reinforcement of the abdominal wall. Traditionally, TAR has been done with an open technique (oTAR), and the benefits of the newer robotic approach (rTAR) has not been well established in the Australian setting. The aim of this study was to compare the results of oTAR with rTAR to demonstrate its safety and efficacy. Methods: A retrospective review of patients who underwent rTAR and oTAR at two tertiary hospitals was conducted between January 2018 and January 2020 in New South Wales, Australia. Patient demographics, perioperative and postoperative outcomes were compared in both groups. Results: There were 26 patients identified to have undergone TAR (13 rTAR, 13 oTAR). Both groups were comparable in regards to age, sex and defect size. oTAR was associated with a higher American Society of Anaesthesiologist score. rTAR was associated with significantly longer average operative time (260.0 ± 78.9 min vs. 185.7 ± 64.5 min, p = 0.017) but found to have a significantly shorter length of stay (3.6 ± 2.1 d vs. 6.9 ± 3.6 d, p = 0.007) with a comparable complication rate. Conclusions: rTAR is associated with shorter length of hospital stay with comparable postoperative outcomes when compared to oTAR. We are seeing increasing evidence supporting the safety and benefits of robotics, however larger scale studies are required to fully understand this approach.

Keywords

• Ventral hernia
• Incisional hernia
• Transversus abdominis release
• Robotic hernia repair