Robotic surgery shows promise for complex abdominal hernias

Robot-assisted surgery could offer a minimally invasive treatment option for patients with complex abdominal wall hernias that are difficult to repair using conventional techniques. A multicentre Israeli study involving 39 patients found that all procedures could be completed robotically, without conversion to open surgery. Most patients were discharged after one day, and no hernia recurrences were recorded during a median follow-up of approximately 14 months.

The findings, published in the scientific journal Hernia, suggest that robotic technology can help surgeons perform technically demanding abdominal wall reconstruction. However, the researchers emphasise that larger comparative studies and longer follow-up are necessary before conclusions can be drawn about long-term effectiveness. The research was led by Michael Freund of the Hebrew University and Shaare Zedek Medical Center, under the guidance of David Hazzan of Raphael Hospital, in collaboration with Sheba Medical Center and Tel Aviv University.

Robotic precision in challenging anatomy

Lateral abdominal wall hernias develop along the sides of the abdomen, rather than in the central abdominal wall or groin. They are relatively uncommon and particularly difficult to repair because of their proximity to the ribs, pelvis, muscles, nerves and blood vessels. Many occur following previous abdominal surgery. In the Israeli study, most patients had developed incisional hernias after procedures involving organs or structures such as the kidneys, intestines or spine. Repairing these defects requires surgeons to close the opening in the abdominal wall and reinforce the surrounding tissue, usually with surgical mesh.

Traditional open surgery provides direct access but may require extensive incisions. Conventional laparoscopy is less invasive, although the limited flexibility of its instruments can make complex reconstruction difficult. Robotic surgical systems offer articulated instruments that can rotate and bend within confined spaces. Combined with magnified three-dimensional visualisation, this allows surgeons to manipulate tissue and position reinforcing mesh with greater flexibility.

The Israeli researchers used a robotic transabdominal preperitoneal approach, known as TAPP. This technique enables surgeons to position mesh between tissue layers, separating it from the abdominal organs. According to Freund, robotic technology is expanding the possibilities for minimally invasive surgery in anatomical areas where conventional instruments offer limited manoeuvrability.

Encouraging outcomes in 39 patients

The retrospective study examined 39 robotic lateral abdominal wall hernia repairs performed between 2018 and 2025. All procedures were completed robotically, with no conversions to open surgery. Median operating time was 150 minutes, while blood loss was minimal. Patients generally experienced limited postoperative pain and required relatively little opioid medication. The median hospital stay was one day.

Nevertheless, complications were not absent. Overall postoperative morbidity was 23.1%, although most complications were minor. Major complications occurred in 7.7% of patients. Two patients developed bowel obstructions requiring additional laparoscopic surgery. Both recovered without bowel resection. No hernia recurrences were observed during a median follow-up of 60.5 weeks.

These findings indicate that robotic reconstruction is technically feasible and can achieve encouraging short-term outcomes in selected patients. However, the absence of recurrences during this relatively limited follow-up does not establish long-term durability. Hernias can recur years after surgery, making extended monitoring essential. The study also lacked a control group undergoing conventional laparoscopic or open surgery. Consequently, it cannot demonstrate that the robotic approach produces better outcomes than alternative techniques.

Previous research

The findings add an important perspective to the broader debate about the clinical value of robotic hernia surgery. In March 2025, we reported on research by University of Michigan Health examining long-term outcomes following robotic, laparoscopic and open ventral hernia repairs. That study found slightly higher ten-year recurrence rates after robot-assisted procedures. Compared with laparoscopic surgery, the difference was approximately 1.1 percentage points, while the difference compared with open surgery was around 0.7 percentage points.

The researchers concluded that robotic surgery had not demonstrated substantial clinical advantages for the broader population undergoing ventral hernia repair. They also highlighted longer operating times and higher costs. However, they acknowledged that robotic systems might offer particular advantages in complex procedures that are difficult to perform laparoscopically. This distinction is relevant to the new Israeli study.

While the Michigan research examined a broader category of abdominal wall hernias, the Israeli researchers focused specifically on uncommon lateral defects requiring technically challenging reconstruction. The results therefore do not contradict the earlier findings. Instead, they suggest that the clinical value of robotic surgery may depend on the complexity and location of the hernia.