The feasibility of robotic inguinal henia repair in Korea.

Laparoscopic inguinal hernia repair is a standard surgical procedure in Korea and worldwide. In the early 1990s, laparoscopic surgery with various types of mesh in the preperitoneal space was introduced [1]. The benefits of this minimally invasive surgery include reduced wound complications, shorter hospital stays, less reported pain, and earlier functional recovery [2,3]. Transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) approaches are representative procedures of laparoscopic surgery for inguinal hernias and have been endorsed in minimally invasive hernia repairs [4,5]. Despite these advantages and published guidelines, laparoscopic inguinal hernia repair surgeries have plateaued, with the number of cases remaining flat for years [6]. Some surgeons have not adopted laparoscopic inguinal hernia repair as their procedure of choice. Reasons include the learning curve required for the advanced laparoscopic technique and the different surgical anatomy compared to open hernia repairs. The peritoneal closure suture technique is also more difficult in the TAPP procedures. Robotic technology offers enhanced visualization and superior dexterity and precision, like wristed instruments for performing minimally invasive operations [7]. In Korea, the performance of robotic inguinal hernia repairs began just a few years ago. A relatively small number of patients have been studied, and there is a debate about the feasibility and advantages of robotic inguinal hernia repair. In this article, Jung et al. [8] showed acceptable short-term results in terms of postoperative complications. However, operation times were longer than open or laparoscopic surgery, and no information was gathered about postoperative pain scores, hospital costs, or patient satisfaction [8]. Khoraki et al. [9] published hospital costs comparing laparoscopic versus robotic inguinal hernia surgery. They concluded that the hospital costs of laparoscopic inguinal hernia repairs were significantly higher than those of robotic inguinal hernia repairs. A large prospective randomized study comparing robotic and laparoscopic surgery is needed to determine the feasibility, patients’ satisfaction, surgeons’ satisfaction, safety, and hernia recurrence of both techniques.