Equal Procedural Cost of Robot-Assisted and Laparoscopic Ventral and Incisional Hernia Repair. A Nationwide Database Study

Abstract Background The use of the robotic platform for ventral hernia repair has increased in the last decades, however, it has been criticized for being too expensive. The aim of this was study was to compare the procedure-specific cost of robot-assisted and laparoscopic ventral and incisional hernia repair including cost of procedure-related readmissions and reoperations within 90 days postoperatively. Methods This was a nationwide database study including 554 robot-assisted ventral and incisional hernia repairs matched 1:1 on hernia type and defect size with laparoscopic repairs. The primary outcome was the total cost per procedure in Euros including the cost of a robotic approach, extra ports, mesh, tackers, length of stay, length of readmission, and operative reintervention. Results For a robot-assisted approach, the mesh was most often placed in the retromuscular position 75.6% (419/554), whereas the mesh was placed in the intraperitoneal position 76.9% (426/554), P 0.001. Likewise, a self-fixating mesh was used significantly more in the robotic group 68.1% (337/554) compared with fixation with tackers in the laparoscopic group 67.3% (373/554), P 0.001. The length of stay was significantly shorter and readmission rate significantly lower for robot-assisted repairs (0.5 days and 7.0%) compared with laparoscopic repairs (1.2 days and 12.5%), P 0.001. The mean total cost of all robot-assisted ventral and incisional hernia repairs was 1,342 euro compared with 1,519 euro for laparoscopic repairs, P = 0.594. Conclusion The procedural cost of a robot-assisted ventral and incisional hernia repair is comparable to the cost of a laparoscopic approach.