Robotic lateral abdominal hernia repair and outcomes a systematic review and proportional meta-analysis.

PURPOSE: Lateral abdominal hernias (LAH) are defined by the presence of a hernia between the linea semilunaris and paraspinal muscles. This type of hernia presents a challenge to repair due to its location and the complex relationship it has with anatomical structures. Traditionally, they were repaired using an open approach; however, over the last decade, minimally invasive surgery (MIS) techniques have gained popularity, with an increased use of robotic platforms. The robotic platform provides dexterity with articulated instruments and enhanced optics, enabling the performance of complex LAH surgeries using the MIS approach. The robotic approach in LAH repairs demands a special skill from surgeons. Literature is scarce regarding the outcomes related to robotic LAH repairs. We aimed to investigate the outcomes of robotic lateral abdominal hernia (r-LAH) repair in this systematic review., We conducted a literature search on the types of lateral hernia according to the EHS classification, hernia repair techniques, intraoperative complications, and post-operative outcomes.

METHODS

This study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. To analyze quality risk-of-bias assessment of all included articles, we applied the Cochrane tools, ROBINS-I, for non-randomized studies. Additionally, we performed a single-arm meta-analysis of post-operative complications, including recurrence, surgical site infection (SSI), seroma, hematoma, and readmission rates. Additionally, we analyzed overall intraoperative complications, conversion rates to open surgery, and length of hospital stay (LOS). Furthermore, a sensitive analysis was conducted to identify possible outlier studies contributing to heterogeneity. Lastly, our proportional meta-analysis was conducted using the metafor package of R software.

RESULTS

Our systematic review search yielded 128 articles across five different databases. After removing duplicates and finishing the screening process, the remaining records were thoroughly assessed with their full text, and a total of 4 reports were finally included in this study, comprising 1,374 patients. After analysis was made, we found a cumulative incidence of recurrence of 1.1% (95% CI [0.06; 16.6]; I2 = 67%), a pooled SSI incidence of 3.4% (95% CI [0.77; 14.2]; I2 = 71%), a seroma incidence of 7.6% (95% CI [4.6; 12.4]; I2 = 0%, and a hematoma incidence of 2.5% (95% CI [0.7; 8.5]; I2 = 43%). Also, we found a cumulative readmission rate of 6.3% (95% CI [2.1; 16.9]; I2 = 57%). Furthermore, our analysis showed a mean LOS of 0.88 days (95% CI 0.7; 1.1]; I2 = 63%). All results presenting with high heterogeneity showed a reduction to 0–2% of heterogeneity after sensitivity analysis.

CONCLUSIONS

This systematic review and proportional meta-analysis demonstrate that the robotic approach for LAH repairs is a safe MIS technique with minimal morbidity and mortality. However, only a few articles have been published in the current literature regarding robotic Lateral Abdominal Hernia repairs, and more prospective studies are needed in the future to evaluate this approach further. “Level of Evidence: Level III, Systematic Review Study.” STUDY REGISTRATION: A review protocol for this systematic review and meta-analysis was registered at PROSPERO (CRD42023407563)