Robotic versus laparoscopic inguinal hernia repair: a systematic review and meta-analysis of randomized controlled trials

Background: Robotic inguinal hernia repair has experienced rapid adoption despite limited high-quality comparative evidence. Previous meta-analyses have mainly focused on non-randomized series, and the only synthesis restricted to RCTs included only three trials and short-term outcomes. This systematic review and meta-analysis synthesizes all available RCT evidence across clinical, patient-reported, and surgeon-centered endpoints. Methods: A systematic search of MEDLINE, Embase, Scopus, Web of Science, and Cochrane CENTRAL was performed. RCTs comparing robotic versus laparoscopic inguinal hernia repair in adults were eligible. Primary outcomes included overall postoperative complications, hernia recurrence, and same-day discharge rate. Secondary outcomes encompassed operative time, chronic postoperative inguinal pain, estimated blood loss, seroma, hematoma, urinary retention, readmission, quality of life, surgeon ergonomics, surgical inflammatory response, stray thermal energy, and procedural cost. Pooled risk ratios (RR), risk difference (RD), or mean differences (MD) with 95% confidence intervals were calculated using the Mantel-Haenszel or inverse-variance method. Heterogeneity was evaluated with the I2 statistic. Risk of bias was assessed using the Cochrane RoB 2 tool, and the certainty of evidence was graded with GRADE. Results: Seven RCTs reported in nine publications (691 patients) were included. No statistically significant differences were found in overall postoperative complications (RR 0.76, 95% CI 0.49-1.17; I2 = 14%; p = 0.22), hernia recurrence (RD - 0.00, 95% CI - 0.02 to 0.02; I2 = 0%; p = 1.00), or same-day discharge rate (RR 1.02, 95% CI 0.93-1.13; I2 = 60%; p = 0.66). All secondary pooled analyses were non-significant. Acute pain could not be pooled due to heterogeneous measurement scales and timepoints across trials. The certainty of evidence was rated low to very low across all outcomes. Conclusions: No statistically significant differences were found between robotic and laparoscopic inguinal hernia repair for any primary or secondary outcome, with low to very low certainty for all endpoints.