# Procedural Costs of Robot-Assisted and Laparoscopic Ventral and Incisional Hernia Repair. A Propensity-Score Matched Nationwide Database Study

## TL;DR

This study compares the costs of robot-assisted and laparoscopic hernia repair, finding that robotic methods can be more cost-effective for incisional hernias.

## Contribution

The study provides new evidence on the cost-effectiveness of robot-assisted hernia repair compared to laparoscopic methods using a nationwide database.

## Key findings

- Robot-assisted repairs had shorter hospital stays and lower readmission rates than laparoscopic repairs.
- For incisional hernias, robot-assisted repair was significantly cheaper than laparoscopic repair.
- Multivariable analysis confirmed robotic repair's cost-saving effect for ventral hernias.

## Abstract

The utilization of the robotic platform for ventral hernia repair is increasing, however is facing criticism for perceived high costs. This study aimed to compare the procedure-specific costs of robot-assisted ventral or incisional hernia repair with laparoscopic repair.

This propensity score-matched nationwide database study included patients undergoing primary ventral and incisional hernia repair from 2017 to 2022. A total of 554 patients undergoing robot-assisted repair were matched 1:1 with patients undergoing laparoscopic repair by the confounding variables of age, type of hernia (primary ventral/incisional), and horizontal defect size. The primary outcome was the total cost per procedure in Euros including robotic/laparoscopic approach, mesh, tackers, length of stay, readmission, and operative reintervention. The price of obtaining laparoscopic and robotic systems was not included.

The length of stay was significantly shorter, and readmission rate was significantly lower for robot-assisted repairs (0.5 days and 7.0%) than for laparoscopic repairs (1.2 days and 12.5%), P < 0.001 and P = 0.003, respectively. The mean procedural cost of an incisional hernia repair was significantly reduced with the robot-assisted approach (1,533 Euros (sd: 1,584)) compared to the laparoscopic approach (2,077 Euros (sd: 1,840), P = 0.002). Multivariable linear regression analysis confirmed that robotic ventral hernia repair was independently associated with decreased overall costs (coeff −682.1, CI −1,331.5 - −32.6, P = 0.040).

For primary ventral hernias, the mean procedural costs of a robot-assisted and a laparoscopic repair are comparable, but for incisional hernia repairs the mean procedural cost is decreased with a robot-assisted approach.