Open versus robotic-assisted repair of midline ventral hernias with defect width 2–8 cm – a randomized clinical trial (OVER)

To compare short-term clinical outcomes, inflammatory response, and patient-reported quality of life after open versus robotic-assisted ventral hernia repair (oVHR vs. rVHR). This randomized controlled trial included adults with midline ventral hernias (2–8 cm). Patients were randomized to oVHR or rVHR. The primary endpoint was postoperative length of stay (LOS). Secondary outcomes included operative time, complications, quality of life, and inflammatory response measured by CRP. The primary outcome was analyzed using Poisson regression adjusted for defect size, repeated measures with linear mixed-effects models, and binary outcomes with logistic regression. Fifty-six patients were analyzed (rVHR = 29, oVHR = 27). Median operative time was longer for rVHR (129 min) than oVHR (80 min, p < 0.001). Mean LOS was significantly shorter after rVHR (0.46 days, 95 % CI 0.21–0.72) than oVHR (1.96 days, 95 % CI 1.43–2.49, p < 0.001). The benefit increased with defect size, corresponding to a predicted one-day difference at 17 cm². Postoperative CRP levels were lower after rVHR on both day 1 (23 vs 46 mg/L, p < 0.001) and day 3 (33 vs 70 mg/L, p < 0.001). Complication rates were similar (21 % vs 26 %, p = 0.6). Quality-of-life improvements at 3 and 6 months were comparable between groups. Robotic-assisted ventral hernia repair was associated with shorter hospitalization particularly for larger defects. The surgical stress response was also significantly lower following rVHR, but with longer operative time and no differences in complications or patient-reported outcomes. ClinicalTrials.gov NCT05906017, registered May 23 2023.