Laparoscopic Versus Robotic Ventral Hernia Repair With Intraperitoneal Mesh: A Systematic Review and Meta-Analysis Comparing the Perioperative Outcomes Randomised Controlled Trials.

Objective: The objective of this meta-analysis is to compare the perioperative surgical outcomes and cost-effectiveness of robotic ventral hernia repair (RVHR) versus laparoscopic ventral hernia repair (LVHR) with intraperitoneal mesh. Methods: Randomised control trials (RCTs) reporting perioperative outcomes and costs in patients undergoing RVHR versus LVHR were selected from medical electronic databases and meta-analysis was conducted in accordance with the guidelines of the Cochrane Collaboration using statistical software RevMan version 5. Results: Four RCTs on 337 patients reporting perioperative outcomes and cost comparison were included. In the random effect model analysis, the duration of operation was shorter, and cost was lower in the LVHR group but with significant statistical heterogeneity [standardized mean difference (SMD) -48.07, 95%, CI (-78.06, -18.07), Z = 3.14, P = 0.002], [SMD 0.82, 95%, CI (-1.48, -0.16), Z = 2.45, P = 0.01]. However, the variables of hernia recurrence and surgical site complications were statistically similar in both groups without any statistical heterogeneity among the included studies [Risk Ratio (RR) 1.05, 95%, CI (0.22, 4.99), Z = 0.06, P = 0.95], [RR 0.85, 95%, CI (0.48, 1.50), Z = 0.55, P = 0.58]. Conclusion: This systematic review demonstrates that RVHR does not offer any superiority among the compared perioperative variables (Duration of operation, hernia recurrence and surgical site complications) and it is not cost-effective when compared to LVHR. Due to the paucity of the RCTs and significant heterogeneity among the compared variables, a major multi-centre RCT is needed to validate these findings.