Robotic vs. laparoscopic TAPP: a systematic review and meta-analysis of randomized controlled trials on short-term outcomes

Abstract

BACKGROUND: Robotic-assisted transabdominal preperitoneal (r-TAPP) inguinal hernia repair is increasingly adopted, yet its short-term advantages over conventional laparoscopy remain uncertain. METHODS: This systematic review was reported according to PRISMA guidelines. A comprehensive search was conducted in MEDLINE, Embase, and CENTRAL until September 25th, 2025. Randomized controlled trials (RCTs) comparing r-TAPP and laparoscopic TAPP were eligible. Primary outcomes were operative time and postoperative complications. A random effects model was used for meta-analysis, and study quality was assessed using the Cochrane RoB II tool. RESULTS: Three RCTs comprising 300 patients were analyzed. Robotic repair was associated with a longer operative time, though this did not reach statistical significance (MD + 17.6 min; 95% CI - 20.7 to + 55.9; p = 0.37). Complication rates were not significantly different (RR 0.83; 95% CI 0.34-2.03; p = 0.68). Readmissions were rare and comparable between groups (RR 0.71; 95% CI 0.09-5.58; p = 0.74). CONCLUSIONS: Robotic TAPP is safe and effective; however, clear superiority over laparoscopy has not been established. Large-scale, multicenter RCTs with standardized protocols, long-term follow-up, and cost-effectiveness analyses are needed to clarify the role of robotics in inguinal hernia repair. PROSPERO REGISTRY: Registration number: CRD420251157847.