Cost-Effectiveness Analysis of Laparoscopic versus Robotic (Hugo™ RAS) Bilateral Inguinal Hernia Repair: A Prospective Study.

Abstract

Bilateral inguinal hernia repair is one of the most frequently performed surgical procedures worldwide. The adoption of robotic-assisted surgery has introduced potential technical advantages; however, its cost-effectiveness compared with conventional laparoscopy remains controversial. This prospective, non-randomized study aimed to evaluate and compare clinical outcomes and cost-effectiveness between laparoscopic transabdominal preperitoneal repair (L-TAPP) and robotic TAPP using the Hugo™ RAS system in bilateral inguinal hernia repair. Patients undergoing surgery between February 2023 and November 2024 were included. Outcomes assessed were operative time, length of hospital stay, postoperative complications, pain scores, recurrence rates, and quality-adjusted life years (QALYs). Costs were analyzed from the hospital perspective. A total of 64 procedures were included (32 laparoscopic and 32 robotic). Robotic procedures were associated with longer operative times but showed significantly lower early postoperative pain scores on postoperative day 1. No statistically significant differences were observed at day 7 or in chronic pain rates. The mean total cost was higher in the robotic group (€4365.80 vs €1690.54). Cost-utility analysis yielded an incremental cost-effectiveness ratio (ICER) of €29,488.16 per QALY gained for the robotic approach. Robotic-assisted TAPP repair using the Hugo™ RAS system is a safe and feasible alternative to laparoscopy, offering comparable clinical outcomes at higher costs.