Robotic Umbilical Hernia Repair Proves Superior to an Open Approach: A Retrospective Comparison of Outcomes

INTRODUCTION: Currently, there is debate over which operative approach to use for umbilical hernia repair (UHR). The objective of the study is to compare the outcomes after robotic vs open UHR. METHODS: A single-center retrospective review of 310 consecutive patients who underwent UHR via the robotic (n = 108) and open (n = 202) approach between November 1, 2016, and February 1, 2020. The primary outcomes were size of mesh placed and hernia recurrence. Secondary outcomes included complication and cost. RESULTS: The results presented are preliminary findings. The average mesh surface area was significantly greater in the robotic cohort (n = 106) with 86 cm2 vs 42 cm2 in the open (n = 10) cohort (p = 0.000005). There were 12 hernia recurrences (6%) occurring at an average of 11.5 ± 8.5 months after repair with the open approach vs zero in the robotic cohort. In open repair there were 11 SSIs (5%) vs 1 (1%) in robotic. The mean BMI was lower in the open cohort with 29.8 ± 5.7 kg/m2 vs 33 ± 5.9 kg/m2 in robotic. The mean length of stay was similar between open and robotic repair with 8.5 hours ± 12.9 vs 8.7 hours ± 7.4, respectively. The average total cost was lower with open repair than with robotic: $18,022 vs $32,349, respectively (p = 0.40). CONCLUSION: The argument that short-term cost advantage of open UHR vs robotic UHR seems to challenge the Hippocratic oath of “do no harm.” The robotic approach is superior to open because it minimizes hernia recurrence, allows for larger size mesh placement, and reduces postoperative morbidity.