Ventral Hernia Repair: A Journey from Laparoscopic to Robotic Surgery: Is Cost Efficiency Guaranteed?

Area of Science:

• Minimally Invasive Surgery
• Surgical Oncology
• Health Economics

Background:

• Ventral hernia repair techniques have advanced with minimally invasive options like laparoscopic intraperitoneal onlay mesh (l-IPOM) and robotic transabdominal preperitoneal robotic repair (rTA-RM).
• While robotic surgery offers enhanced precision, its higher cost raises concerns about cost-effectiveness compared to laparoscopic methods.

Purpose of the Study:

• To compare the cost-effectiveness of robotic transabdominal preperitoneal robotic repair (rTA-RM) versus laparoscopic intraperitoneal onlay mesh (l-IPOM) for ventral hernia repair.
• To analyze surgical outcomes, hospital costs, and supply expenses between the two minimally invasive techniques.

Main Methods:

• A retrospective analysis of 30 patients undergoing rTA-RM and 30 undergoing l-IPOM for ventral hernias between February 2022 and October 2023.
• Propensity score matching (PSM) was utilized to ensure group comparability.
• Data collected included demographics, surgical outcomes, and detailed cost breakdowns (capital, disposable supplies, hospital stay).

Main Results:

• The rTA-RM group experienced longer operative times (93.2 vs. 74.4 min) but significantly shorter hospital stays (1 vs. 2 days) and reduced postoperative pain (VAS 3 vs. 5).
• Overall total costs were comparable (EUR 6862 for rTA-RM vs. EUR 6575 for l-IPOM).
• Robotic surgery incurred higher capital costs but substantially lower disposable supply costs (EUR 1057 vs. EUR 2006).

Conclusions:

• Despite higher initial investment, robotic ventral hernia repair (rTA-RM) demonstrates cost-competitiveness with l-IPOM.
• Lower disposable supply costs and shorter hospitalizations contribute to the comparable overall economic profile of robotic surgery.
• Further investigation into long-term outcomes and broader economic impacts of rTA-RM is warranted.