Comparing robotic ventral transabdominal preperitoneal repair (rvTAPP) and laparoscopic enhanced view totally extraperitoneal repair (eTEP): a multicentre observational study

Abstract

This study compares two emerging minimally invasive techniques-laparoscopic enhanced-view totally extraperitoneal (eTEP) and robotic ventral transabdominal preperitoneal repair (rvTAPP)-for the repair of small and mid-sized ventral hernias. A prospective observational study was conducted using data from the international CROSSFIRE database with patients treated between January 2023 and December 2024. The inclusion criteria were primary and incisional midline ventral hernias ≤ 4 cm, treated with eTEP or rvTAPP. The group comparisons were conducted using propensity score matching, adjusting for differences in body mass index, sex, and hernia defect. A total of 165 patients from three centers were included (120 eTEP, 45 rvTAPP). After propensity score matching, 100 patients were included (57 eTEP and 43 rvTAPP). The pain scores after eTEP and rvTAPP at 2 days postoperatively (2.9 vs. 3.3, p = 0.385) and at 6 weeks (2.1 vs. 2.1, p = 0.888) were comparable. The mean comprehensive complication index was similar between eTEP and rvTAPP (1.7 vs. 1.5, p = 0.561). The operation time was 88.8 min for eTEP and 110.1 min for rvTAPP (p = 0.003), whereas rvTAPP involved more teaching procedures (32.6% versus 8.8%; p = 0.004). Surgeon workload, as assessed by NASA Task Load Index, was higher in eTEP than rvTAPP (36.3 vs. 17.1; p < 0.001), indicating greater physical and mental strain. Both posterior minimally invasive ventral hernia repair techniques-eTEP and rvTAPP-are safe and show comparable pain levels at 2 days and 6 weeks. Robotically assisted ventral TAPP has a longer operative time than eTEP but imposes less workload on the surgeon.