Robotic Versus Laparoscopic Transabdominal Preperitoneal Inguinal Hernia Repair: An Updated Systematic Review and Meta-Analysis of Randomized Controlled Trials

Background: Robotic transabdominal preperitoneal inguinal hernia repair (r-TAPP) has been increasingly adopted, but whether it provides clinical advantages over conventional laparoscopic TAPP (l-TAPP) remains uncertain. This systematic review and meta-analysis aimed to provide an updated synthesis of randomized evidence comparing r-TAPP with l-TAPP. Methods: We searched PubMed/MEDLINE, Scopus, and CENTRAL from inception through August 3, 2026, without language restrictions. Randomized controlled trials (RCTs) comparing r-TAPP with l-TAPP in adults undergoing inguinal hernia repair were eligible. We performed random-effects meta-analyses using risk ratios (RRs) for dichotomous outcomes and mean differences (MDs) for continuous outcomes, with 95% confidence intervals (CIs). We estimated between-study variance using restricted maximum likelihood and quantified heterogeneity using I 2 . We assessed risk of bias and certainty of evidence using RoB 2 and GRADE, respectively. Results: Five publications representing four independent RCTs comprising 401 patients were included. Of these, 195 patients underwent r-TAPP and 206 underwent l-TAPP. No statistically significant differences were observed in overall postoperative complications (RR: 0.89; 95% CI: 0.45–1.78; I 2 = 39.5%), conversion (RR: 1.00; 95% CI: 0.09–10.91; I 2 = 11.7%), operative time (MD: + 18.5 minutes; 95% CI: −8.4 to 45.5; I 2 = 97.7%), seroma (RR: 0.40; 95% CI: 0.08 to 2.03; I 2 = 0%), hematoma (RR: 0.65; 95% CI: 0.12–3.41; I 2 = 48.0%), or surgical site infection (RR: 0.33; 95% CI: 0.03–3.14; I 2 = 0%). Operative time showed substantial between-study heterogeneity, while estimates for postoperative complications were limited by sparse events and wide confidence intervals. Conclusions: Current evidence has not demonstrated a clear clinical advantage of r-TAPP over l-TAPP for short-term outcomes. However, the available evidence remains limited by the relatively small overall sample size, sparse events, imprecision, and substantial heterogeneity in operative time. Larger multicenter randomized trials with standardized outcome definitions and longer follow-up are needed to determine whether clinically meaningful differences exist between approaches.