Short-term outcomes of robotic versus laparoscopic TAPP for inguinal hernia repair: a systematic review, meta-analysis, and GRADE assessment

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Robotic transabdominal preperitoneal (R-TAPP) repair has gained increasing adoption in inguinal hernia surgery, yet its short-term clinical value relative to conventional laparoscopic TAPP (L-TAPP) remains debated. Although robotic platforms offer technical and ergonomic advantages, whether these translate into measurable patient-centered benefits is uncertain. This systematic review and meta-analysis aimed to provide an updated comparative evaluation of short-term safety, efficacy, economic impact, and surgeon workload between R-TAPP and L-TAPP. A systematic review adhering to PRISMA 2020 standards was conducted across five major databases from inception through September 2025. Randomized controlled trials and comparative observational studies involving adult patients undergoing R-TAPP or L-TAPP were included. The primary endpoint was chronic postoperative inguinal pain. Secondary outcomes comprised operative duration, estimated blood loss, length of hospital stay, postoperative complications, recurrence, readmission, reoperation, urinary outcomes, surgical site infection, procedural costs, and surgeon workload assessed using the NASA Task Load Index (NASA-TLX). Risk of bias was evaluated using RoB 2 and ROBINS-I tools, and pooled analyses were performed using random-effects models. Fourteen independent studies (3 randomized trials and 11 cohort studies) encompassing 5,520 patients met the inclusion criteria. The incidence of chronic postoperative pain (n = 616) did not differ significantly between approaches (RR 0.58; 95% CI 0.30–1.12; p = 0.11; I² = 0%). Robotic repair was associated with prolonged operative time (MD 10.93 min; 95% CI 4.18–17.67; p = 0.002). No statistically significant differences were observed in blood loss, hospital stay, overall morbidity, recurrence, readmission, reoperation, urinary retention, urinary tract infection, or surgical site infection. While total NASA-TLX scores were comparable, robotic surgery significantly reduced the surgeon’s physical workload. Procedural costs were consistently higher in the robotic cohort. R-TAPP provides short-term clinical outcomes comparable to L-TAPP but is associated with longer operative times and increased direct costs. Its principal advantage appears to lie in improved surgeon ergonomics rather than superior patient outcomes. Robotic repair may therefore be most appropriate in complex cases or high-volume centers with established expertise, whereas laparoscopic TAPP remains a cost-efficient standard for routine inguinal hernia repair.

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