Background

Since the introduction of minimally invasive surgery, new techniques like transabdominal preperitoneal (TAPP) repair have progressively gained acceptance for the treatment of groin hernia. Laparoscopic TAPP (LTAPP) is recommended for bilateral repairs. Likewise, the introduction of robotic platforms has promised additional surgical benefits for robotic TAPP (RTAPP), which are yet to be confirmed. This study compared multicenter data obtained from patients undergoing bilateral inguinal hernia repair with RTAPP, performed during the preliminary learning curve period, versus conventional LTAPP.

Materials and methods

All consecutive bilateral inguinal hernia patients from four Italian centers between June 2015 and July 2020 were selected. A propensity score model was used to compare patients treated with LTAPP versus RTAPP, considering sex, age, body mass index, current smoking status, overall comorbidity, hernia classification (primary or recurrent), and associated procedures as covariates. After matching, intraoperative details and postoperative outcomes were evaluated.

Results

In total, 275 LTAPP and 40 RTAPP were performed. After matching, 80 and 40 patients were allocated to the LTAPP and RTAPP cohorts, respectively. No intraoperative complications or conversion to open surgery occurred. However, a longer operative time was recorded in the RTAPP group (79 ± 21 versus 98 ± 29 min; p < 0.001). Postoperative visual analog scale (VAS) pain scores (p = 0.13) did not differ and complication rates were similar. There were no clinical recurrences in either group, with mean follow-up periods of 52 ± 14 (LTAPP) and 35 ± 8 (RTAPP) months. A statistical difference in length of hospital stay was found between the groups (1.05 ± 0.22 vs 1.50 ± 0.74 days; p < 0.001).

Conclusion

In this patient population, outcomes for bilateral inguinal hernia repair appear comparable for RTAPP and LTAPP, except for a shorter recovery after laparoscopic surgery. A longer operative time for robotic surgery could be attributable to the learning curve period of each center.

中文翻译：

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双侧疝修复的机器人与腹腔镜经腹腹膜前 (TAPP) 方法：一项使用倾向评分匹配分析的多中心回顾性研究

背景

自从引入微创手术以来，经腹腹膜前 (TAPP) 修复等新技术已逐渐被接受用于治疗腹股沟疝。建议使用腹腔镜 TAPP (LTAPP) 进行双侧修复。同样，机器人平台的引入已承诺为机器人 TAPP (RTAPP) 带来额外的手术益处，但尚未得到证实。这项研究比较了从接受双侧腹股沟疝修补术的患者获得的多中心数据，在初步学习曲线期间进行的 RTAPP 与传统的 LTAPP。

材料和方法

选择了 2015 年 6 月至 2020 年 7 月期间来自意大利四个中心的所有连续双侧腹股沟疝患者。使用倾向评分模型比较接受 LTAPP 和 RTAPP 治疗的患者，将性别、年龄、体重指数、当前吸烟状况、总体合并症、疝分类（原发性或复发性）以及相关手术作为协变量。匹配后，评估术中细节和​​术后结果。

结果

总共执行了 275 次 LTAPP 和 40 次 RTAPP。匹配后，分别将 80 名和 40 名患者分配到 LTAPP 和 RTAPP 队列。没有发生术中并发症或转为开放手术。然而，RTAPP 组记录了更长的手术时间（79 ± 21 对 98 ± 29 分钟；p  < 0.001）。术后视觉模拟量表 (VAS) 疼痛评分 ( p  = 0.13) 没有差异，并发症发生率相似。两组均未出现临床复发，平均随访时间分别为 52 ± 14 (LTAPP) 和 35 ± 8 (RTAPP) 个月。两组间的住院时间存在统计学差异（1.05 ± 0.22 vs 1.50 ± 0.74 天；p  < 0.001）。

结论

在这个患者群体中，双侧腹股沟疝修补术的结果似乎与 RTAPP 和 LTAPP 相当，除了腹腔镜手术后恢复较短。机器人手术较长的手术时间可能归因于每个中心的学习曲线周期。