Contemporary inguinal hernia repair: do cost and operative time still differ by approach?

Background: Concerns about the expense of robotic surgery for inguinal hernia repairs have emerged alongside the growing interest and skill in robotic techniques over the past decade. This study aimed to assess whether the costs of robotic inguinal hernia repairs are comparable to those of laparoscopic or open methods.

Methods: We conducted a retrospective analysis of consecutive open, laparoscopic, and robotic inguinal hernia repairs using mesh at a single tertiary academic medical center from 2020 to 2023. We compared costs and operation times for initial unilateral and bilateral cases.

Results: In unilateral repairs-open (n = 384), laparoscopic (n = 35), and robotic (n = 312)-the median operative times were 62, 67, and 67 min, respectively. Open repairs were quicker than laparoscopic (p = 0.010), but no significant difference was noted compared to robotic repairs (p = 0.066), and there was no substantial difference between laparoscopic and robotic repairs (p = 0.5). The total costs for unilateral open repairs ($11,218) were lower than the costs for laparoscopic ($13,819, p =  < 0.001) or robotic ($15,610, p =  < 0.001) repairs, with laparoscopic also being less expensive than robotic (p = 0.019). For bilateral repairs, the median operative times were 104 min for open (n = 56), 101 min for laparoscopic (n = 23), and 88 min for robotic (n = 70). There were no significant differences in times between open and laparoscopic repairs (p = 0.6); however, robotic repairs were quicker than both open (p = 0.012) and laparoscopic (p = 0.017) repairs. The cost for laparoscopic bilateral repair was higher compared to open ($19,727 vs $18,516, p = 0.014), but robotic surgery ($19,172) did not show a significant difference when compared to open (p = 0.11) or laparoscopic (p = 0.4) repairs.

Conclusions: Bilateral inguinal hernia repair is performed most quickly using robotic techniques and exhibits costs similar to those of open and laparoscopic surgery. Further studies exploring how surgeon experience with robotics affects costs and operative time are necessary.