Robotic-assisted primary ventral and incisional hernia repair: a comprehensive comparative analysis of rv-TAPP, r-Rives, and r-TARUP techniques.

Abstract

Robotic-assisted surgery has transformed hernia repair by improving precision, minimizing postoperative complications, and accelerating recovery. This study evaluates three robotic techniques-robotic transabdominal preperitoneal (rTAPP), robotic Rives (rRives), and robotic transabdominal retromuscular umbilical prosthetic (rTARUP)-for treating primary ventral and incisional hernias. Following PRISMA guidelines, a systematic review and meta-analysis were conducted. Databases such as PubMed, Embase, Cochrane Library, and Web of Science were searched for studies comparing rTAPP, rRives, and rTARUP. Key outcomes included recurrence rates, surgical duration, and postoperative complications, with secondary outcomes assessing hospital stay and cost-effectiveness. Statistical analyses were performed using RevMan 5.4 and STATA 16, calculating pooled odds ratios (OR) and mean differences (MD). Heterogeneity was measured via I² statistics, and publication bias was evaluated using the Egger test. The analysis included 18 studies encompassing 1,500 patients. rTAPP showed shorter operative times (MD: - 25.3 min, 95% CI: - 30.1 to - 20.5, *p* < 0.05) and reduced recurrence rates (OR: 0.45, 95% CI: 0.30-0.68, *p* < 0.01) compared to rRives and rTARUP. However, rTARUP was linked to fewer postoperative complications (OR: 0.65, 95% CI: 0.50-0.85, *p* < 0.05). No significant publication bias was detected (Egger test, *p* = 0.12). Robotic hernia repair techniques offer unique benefits: rTAPP is more efficient, while rTARUP reduces complications. These results emphasize the need for personalized surgical approaches.