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

Authors

Fernanda de Moraes Nava, Vitória Maia Corrêa, Felippe Furlan Kelher, Lucas Monteiro Delgado, Claudia Theis, Sérgio Mazzola Poli de Figueiredo, Fábio Israel Lima Castelo Branco Marques, Bernardo Fontel Pompeu

Published in

Journal of laparoendoscopic & advanced surgical techniques. Part A. Pages 10926429261501679. Oct 25, 2026. Epub Oct 25, 2026.

Abstract

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.
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 I². We assessed risk of bias and certainty of evidence using RoB 2 and GRADE, respectively.
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; I² = 39.5%), conversion (RR: 1.00; 95% CI: 0.09-10.91; I² = 11.7%), operative time (MD: + 18.5 minutes; 95% CI: -8.4 to 45.5; I² = 97.7%), seroma (RR: 0.40; 95% CI: 0.08 to 2.03; I² = 0%), hematoma (RR: 0.65; 95% CI: 0.12-3.41; I² = 48.0%), or surgical site infection (RR: 0.33; 95% CI: 0.03-3.14; I² = 0%). Operative time showed substantial between-study heterogeneity, while estimates for postoperative complications were limited by sparse events and wide confidence intervals.
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.

PMID:
42927985
Bibliographic data and abstract were imported from PubMed on 26 Oct 2026.

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