At this point, it’s not a secret that I am not a fan of robotic inguinal hernia repairs.
I’ve talked about it many times before, specifically in my “Do Both Sides of Your Hernia Really Need a Robot?” , “When High Tech Isn’t High Value…”, and “The Truth About Hernia Repairs…” blog posts.
However, despite growing evidence and ongoing discussion, robotic inguinal hernia repairs continue to increase in popularity.
Last month, the ROGER trial was published, and it further supports my point. This prospective, randomized study evaluated 182 patients undergoing elective primary inguinal hernia repair at a single institution. Patients were randomly assigned to one of two groups:
Group 1: Laparoscopic inguinal hernia repair
Group 2: Robotic inguinal hernia repair
After their surgery, researchers compared postoperative pain, operating time, and complication rates.
Unsurprisingly, there was no significant difference in the pain or compilation rates for the two repairs. If anything, the patients who underwent the laparoscopic repair were in slightly less pain 30 days post-op.
There is one more thing…
In the conclusion of the paper, it reads, “(Robotic Inguinal Hernia Repairs) demonstrated no superiority over (Laparoscopic) regarding postoperative pain and complication rates. (Robotic) was associated with a reduced surgeon workload at the expense of a longer operating time.”
Read that carefully. Robotic repairs take longer, which increases overall cost, but make the procedure easier for the surgeon. That raises an important question: are we prioritizing outcomes for patients, or convenience for the surgeon?
The take home message from this trial echoes what I have been saying for years: in the vast majority of cases, inguinal hernia repair does not require entry into the peritoneal cavity, robotic technology or the use of general anesthesia.
At my practice in Boston, we recreate the laparoscopic repair in an open setting, which further improves patients’ outcomes following an inguinal hernia repair. If you are interested in reading more about the fast recovery repair, you can click here.
Suggested references:
Reinhorn, M., Fullington, N., Agarwal, D., Olson, M. A., Ott, L., Canavan, A., Pate, B., Hubertus, M., Urquiza, A., Poulose, B., & Warren, J. (2023). Posterior mesh inguinal hernia repairs: a propensity score matched analysis of laparoscopic and robotic versus open approaches. Hernia : the journal of hernias and abdominal wall surgery, 27(1), 93–104. https://doi.org/10.1007/s10029-022-02680-0
Feliu X, Clavería R, Besora P, Camps J, Fernández-Sallent E, Viñas X, Abad JM. Bilateral inguinal hernia repair: laparoscopic or open approach? Hernia. 2011;15(1):15-18. doi:10.1007/s10029-010-0736-2. PMID: 20960019.
Rodrigues-Gonçalves, V., Verdaguer-Tremolosa, M., Martínez-López, P., Fernandes, N., Bel, R., & López-Cano, M. (2024). Open vs. robot-assisted preperitoneal inguinal hernia repair. Are they truly clinically different?. Hernia : the journal of hernias and abdominal wall surgery, 28(4), 1355–1363. https://doi.org/10.1007/s10029-024-03050-8
Schiano di Visconte M. (2025). Cost-utility of robotic versus laparoscopic TAPP for inguinal hernia: a model‑based analysis from a public payer perspective. Hernia : the journal of hernias and abdominal wall surgery, 30(1), 11. https://doi.org/10.1007/s10029-025-03513-6