The paradox of the robotic approach to inguinal hernia repair in the inpatient setting

Background: Robotics offers improved ergonomics, enhanced visualization, and increased dexterity. Disadvantages include startup, maintenance and instrument costs. Surgeon education notwithstanding, we hypothesized that robotic inguinal hernia repair carries minimal advantages over the open or laparoscopic approach in the inpatient setting. Methods: The HCUP-SID and AHA datasets were queried for inguinal hernia repair codes. Hospital and patient demographic, financial and comorbidity data were evaluated. Data are presented as mean +/- SEM. Results: 36396 cases (27776 Open, 7104 Laparoscopic and 1516 Robotic) were identified. Total costs were: $13595 +/- 104 (Open), $13581 +/- 176 (Laparoscopic) and $18494 +/- 323 (Robotic). (p <0.0001 Robotic vs Open, Robotic vs Laparoscopic) Robotic costs were 38% greater than that of the Open and Laparoscopic subsets (p <0.001 Robotic vs. Open and Laparoscopic). The Open, Laparoscopic and Robotic subsets' length of stay were 4.2, 3.2 and 2.3 days, respectively. (p <0.0001 among Open, Laparoscopic and Robotic). Conclusion: The Robotic approach to the inguinal hernia repair had the lowest length of stay, despite having the highest costs. The benefits of robotic surgery in inguinal hernia repair are unclear in the inpatient setting. (C) 2019 Elsevier Inc. All rights reserved.