Comparison of Costs Between Robotic Versus Laparoscopic Approach to Inguinal Hernia. Is It Sustainable?

Abstract Aim There has been a rapid growth in the robotic approach to inguinal hernia. This is because it has demonstrated similar results to the laparoscopic approach but with a significant increase in associated costs. Our objective is to conduct a cost analysis in Spanish National Health System. Materials and Methods A retrospective single-center comparative study of cost on inguinal hernia repair using a robotic approach versus laparoscopic approach. Results 98 patients who underwent inguinal hernia repair were analyzed between October 2021 and July 2023. Out of these 98 patients, 20 (20.4%) were treated with the robotic approach, while 78 (79.6%) underwent the laparoscopic approach. When comparing both approaches, no significant differences were found in terms of complications, recurrences, or readmissions. However, the robotic group exhibited a longer surgical time (86 ± 33.07 min vs. 40 ± 14.46 min, p 0.001), an extended hospital stay (1.6 ± 0.503 days vs. 1.13 ± 0.727 days, p 0.007), as well as higher procedural costs (2810.15€ ± 218.10€ vs. 725.81€ ± 158.91€, p 0.001) and total hospitalitation costs (3792.49€ ± 326.06€ vs. 1497.20€ ± 375.68 €, p 0.001). These results were consistent when performing subgroup analysis for unilateral and bilateral hernias. Conclusions The benefits observed in terms of recurrence rates and post-surgical complications do not justify the additional costs incurred by the robotic approach to inguinal hernia within the national public healthcare system. Nevertheless, it represents a simpler way to initiate the robotic learning curve, justifying its use in a training context.