ROBOTIC SURGERY AS A TOOL FOR INCREASED DEXTERITY IN MINIMALLY INVASIVE HERNIA SURGERY – AN ANALYSIS OF TRENDS AND BASELINE COMPARISON OF 10 YEARS OF MIS VENTRAL HERNIA REPAIRS IN THE UNITED STATES USING THE ACHQC DATABASE

摘要

Abstract Aim To evaluate the dexterity in Minimally invasive ventral hernia repair (VHR) in the last 10 years in the United States utilizing the Abdominal Core Health Quality Collaborative (ACHQC) database. Materials and Methods A retrospective review of prospectively collected data from the ACHQC database was performed to include all adult patients that underwent laparoscopic and robotic VHR in the last 10 years. Univariate analysis was performed to compare outcomes from laparoscopic and robotic-assisted approaches across preoperative, intraoperative and postoperative outcomes in two different periods in time. Results ACHQC database identified 15,437 patients that underwent VHR. Patients were divided into four groups: Laparoscopic 2013–2017 (Lap1) (n = 2,535), Robotic 2013–2017 (n = 1,806) (Robot1), Laparoscopic 2018–2022 (n = 2,063) (Lap2), and Robotic 2018–2022 (n = 9,033) (Robot2). Median Hernia width was higher in the Robot2 (4 cm IQR 2–6) when compared to the lap2 group (3 cm IQR 2–5) (p <0.001). Retromuscular repair was higher in the Robot2 group when compared to Lap2 group (n = 3201; 37.6% versus n = 68; 4.2%) and to the Robot1 group (n = 419; 24.7%) (p <0.001). Fascial closure was higher in the Robot2 group when compared to Lap2 group (n = 8649; 96.5% vs. n = 1359; 67.3%) and to the Robot1 group (n = 1736; 96.1%) (p <0.001). There was no difference in SSI between groups and SSO/I was lower in the Robot2 group when compared to Lap2 and Robot1 groups. Readmission rate was lower in the Robot2 group when compared to Robot1 (2.6% vs. 2.9%, p = 0.009). Conclusions Robotic approach was associated with more technically challenging repairs with lower complication rates over time.