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<p>Transabdominal preperitoneal (TAPP) repair is the gold standard for minimally invasive inguinal hernia surgery. With the advent of robotic surgery, robotic-assisted TAPP (r-TAPP) has emerged as an alternative to conventional laparoscopic TAPP (l-TAPP), although comparative evidence remains limited. We conducted a prospectively registered systematic review and meta-analysis (PROSPERO ID: CRD420251154089) of randomized controlled trials comparing r-TAPP and l-TAPP in adults with inguinal hernias. We searched MEDLINE, Embase, Cochrane CENTRAL, Web of Science, Scopus, ClinicalTrials.gov, WHO ICTRP, and Google Scholar from inception to September 2025 for relevant studies. The primary outcomes were operative duration and postoperative complications within 30 days. The secondary outcomes included seroma, hematoma, urinary retention, and readmission rates. A random-effects meta-analysis was performed using RevMan 5.4. Evidence certainty was assessed using the GRADE methodology. Three randomized controlled trials encompassing 379 patients (196 r-TAPP and 183&#xa0;l-TAPP) met the inclusion criteria. Overall operative time showed no significant difference (MD 0.59&#xa0;min, 95% CI -23.67 to 24.85, I²=98%). However, sensitivity analysis removing the heterogeneity-driving study revealed r-TAPP advantage (-15.20&#xa0;min, 95% CI -18.58 to -11.82, <i>p</i> &lt; 0.00001). No statistically significant differences were observed for any postoperative complication (OR 0.84, 95% CI 0.19–3.79), seroma (OR 1.00, 95% CI 0.13–8.01), hematoma (OR 0.64, 95% CI 0.08–5.30), urinary retention (OR 0.55, 95% CI 0.17–1.76), or readmission (OR 0.51, 95% CI 0.02–12.14). GRADE certainty ranged from low to very low because of imprecision and inconsistency. Across three randomized trials, r-TAPP and l-TAPP showed similar short-term safety with no confirmed difference in operative time. Substantial heterogeneity—likely related to trial design and experience—limits certainty, and publication bias cannot be reliably assessed with so few studies. Larger, multicenter RCTs with standardized protocols and definitions are needed to establish comparative effectiveness.</p>

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Da Vinci Xi versus laparoscopic transabdominal preperitoneal (TAPP) repair of inguinal hernia: a GRADE-assessed systematic review and meta-analysis of randomized controlled trials

  • 期刊论文

  • 发表日期：

    2025年11月3日

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  • Wajahat Mirza,
  • Mehak Ejaz Khan,
  • Hania Iqbal,
  • Alishbah Khan,
  • Hadi Mohammad Khan,
  • Hamza Nasir Chatha,
  • Eshan Ahmad,
  • Sundus Dadan,
  • Abdul Rafeh Awan,
  • Muhammad Ahmad Nadeem

摘要

Transabdominal preperitoneal (TAPP) repair is the gold standard for minimally invasive inguinal hernia surgery. With the advent of robotic surgery, robotic-assisted TAPP (r-TAPP) has emerged as an alternative to conventional laparoscopic TAPP (l-TAPP), although comparative evidence remains limited. We conducted a prospectively registered systematic review and meta-analysis (PROSPERO ID: CRD420251154089) of randomized controlled trials comparing r-TAPP and l-TAPP in adults with inguinal hernias. We searched MEDLINE, Embase, Cochrane CENTRAL, Web of Science, Scopus, ClinicalTrials.gov, WHO ICTRP, and Google Scholar from inception to September 2025 for relevant studies. The primary outcomes were operative duration and postoperative complications within 30 days. The secondary outcomes included seroma, hematoma, urinary retention, and readmission rates. A random-effects meta-analysis was performed using RevMan 5.4. Evidence certainty was assessed using the GRADE methodology. Three randomized controlled trials encompassing 379 patients (196 r-TAPP and 183 l-TAPP) met the inclusion criteria. Overall operative time showed no significant difference (MD 0.59 min, 95% CI -23.67 to 24.85, I²=98%). However, sensitivity analysis removing the heterogeneity-driving study revealed r-TAPP advantage (-15.20 min, 95% CI -18.58 to -11.82, p < 0.00001). No statistically significant differences were observed for any postoperative complication (OR 0.84, 95% CI 0.19–3.79), seroma (OR 1.00, 95% CI 0.13–8.01), hematoma (OR 0.64, 95% CI 0.08–5.30), urinary retention (OR 0.55, 95% CI 0.17–1.76), or readmission (OR 0.51, 95% CI 0.02–12.14). GRADE certainty ranged from low to very low because of imprecision and inconsistency. Across three randomized trials, r-TAPP and l-TAPP showed similar short-term safety with no confirmed difference in operative time. Substantial heterogeneity—likely related to trial design and experience—limits certainty, and publication bias cannot be reliably assessed with so few studies. Larger, multicenter RCTs with standardized protocols and definitions are needed to establish comparative effectiveness.