Kudsi Omar Yusef, Bou-Ayash Naseem, Kaoukabani Georges, Gokcal Fahri
Department of Surgery, Good Samaritan Medical Center, One Pearl Street, Brockton, MA, 02301, USA.
Department of Surgery, Tufts Medical Center, Boston, MA, USA.
Surg Endosc. 2023 Feb;37(2):1508-1514. doi: 10.1007/s00464-022-09433-1. Epub 2022 Jul 18.
Although the advantages of laparoscopic inguinal hernia repair (LIHR) have been described, guidelines regarding robotic inguinal hernia repair (RIHR) have yet to be established, despite its increased adoption as a minimally invasive alternative. This study compares the largest single-center cohorts of LIHR and RIHR and aims to shed light on the differences in outcomes between these two techniques.
Patients who underwent LIHR or RIHR over an 8-year period were included as part of a retrospective analysis. Variables were stratified by preoperative, intraoperative, and postoperative timeframes. Complications were listed according to the Clavien-Dindo classification system and comprehensive complication index (CCI®). Study groups were compared using univariate analyses and Kaplan-Meier's time-to-event analysis.
A total of 1153 patients were included: 606 patients underwent LIHR, while 547 underwent RIHR. Although demographics and comorbidities were mostly similar between the groups, the RIHR group included a higher proportion of complex hernias. Operative times were in favor of LIHR (42 vs. 53 min, p < 0.001), while RIHR had a smaller number of peritoneal breaches (0.4 vs. 3.8%, p < 0.001) as well as conversions (0.2 vs. 2.8%, p < 0.001). The number of patients lost-to-follow-up and the average follow-up times were similar (p = 0.821 and p = 0.304, respectively). Postoperatively, CCI® scores did not differ between the two groups (median = 0, p = 0.380), but Grade IIIB complications (1.2 vs. 3.3%, p = 0.025) and recurrences (0.8% vs. 2.9%, p = 0.013) were in favor of RIHR. Furthermore, estimated recurrence-free time was higher in the RIHR group [p = 0.032; 99.7 months (95% CI 98.8-100.5) vs. 97.6 months (95% CI 95.9-99.3).
This study demonstrated that RIHR may confer advantages over LIHR in terms of addressing more complex repairs while simultaneously reducing conversion and recurrence rates, at the expense of prolonged operation times. Further large-scale prospective studies and trials are needed to validate these findings and better understand whether RIHR offers substantial clinical benefit compared with LIHR.
尽管腹腔镜腹股沟疝修补术（LIHR）的优势已被描述，但关于机器人腹股沟疝修补术（RIHR）的指南尚未建立，尽管它作为一种微创替代方法的应用越来越多。本研究比较了LIHR和RIHR最大的单中心队列，旨在阐明这两种技术在治疗效果上的差异。
作为回顾性分析的一部分，纳入了在8年期间接受LIHR或RIHR的患者。变量按术前、术中和术后时间框架进行分层。并发症根据Clavien-Dindo分类系统和综合并发症指数（CCI®）列出。使用单因素分析和Kaplan-Meier事件发生时间分析对研究组进行比较。
共纳入1153例患者：606例患者接受了LIHR，547例接受了RIHR。尽管两组之间的人口统计学和合并症大多相似，但RIHR组中复杂疝的比例更高。手术时间有利于LIHR（42分钟对53分钟，p<0.001），而RIHR的腹膜破裂数量较少（0.4%对3.8%，p<0.001）以及中转率较低（0.2%对2.8%，p<0.001）。失访患者数量和平均随访时间相似（分别为p = 0.821和p = 0.304）。术后，两组之间的CCI®评分没有差异（中位数=0，p = 0.380），但ⅢB级并发症（1.2%对3.3%，p = 0.025）和复发率（0.8%对2.9%，p = 0.013）有利于RIHR。此外，RIHR组的估计无复发生存时间更高[p = 0.032；99.7个月（95%CI 98.8-100.5）对97.6个月（95%CI 95.9-99.3）]。
本研究表明，RIHR在处理更复杂的修补方面可能比LIHR更具优势，同时降低中转率和复发率，但代价是手术时间延长。需要进一步的大规模前瞻性研究和试验来验证这些发现，并更好地了解与LIHR相比，RIHR是否提供实质性的临床益处。
