Common Recommendations in the US
Many surgeons now routinely recommend robotic inguinal hernia repair with mesh for inguinal hernias. While we agree that this is a great option in many patients, we believe that many times there are better options available.
The Difference in Recovery Among Different Techniques
In our experience, open, laparoscopic, and robotic repairs all have similar recoveries. Our open tissue repairs tend to have slightly more pain for the first few days but after the first 3-5 days, recoveries are very similar.
Our First-Line Recommendation
We tend to recommend open repairs for uncomplicated inguinal hernias for the following reasons:
- Anesthesia required is less (twilight vs general anesthesia with paralysis needed for robotic surgery)
- The peritoneal cavity is not entered and remains undisturbed (robotic surgery almost always enters the peritoneal cavity)
- The risk of serious complications such as small bowel obstructions, visceral injuries, and hematomas is essentially zero with the open approach (these issues are not common but do happen with the intraperitoneal approaches such as robotics)
- We are able to close the hernia defect which gives us maximal flexibility with choosing whether or not a patch is needed, and if mesh is chosen, light-weight options are almost always adequate (large defects are rarely able to be safely closed by laparoscopy or robotics)
The Cober Method
We most often utilize the Cober Method which is our adaptation of the current techniques to match the best repairs with the unique anatomy present in each patient. You can read more about the method here.
When is the Robotic Approach Best?
We do acknowledge the utility of the robotic platform but generally consider it best used in cases of obese patients, and for mesh removals where the mesh was placed from the posterior approach.
Summary
While robotic surgery has many advantages, the significant variability present in inguinal hernia anatomy leads us to currently most often recommend open approaches under lighter anesthesia and we utilize the Cober Method to craft the best repair for a patient’s particular anatomy.