The Role of the Robotic Platform in Inguinal Hernia Repair Surgery
The Role of the Robotic Platform in Inguinal Hernia Repair Surgery
Inguinal hernia repair is one of the most commonly performed general surgery operations.
 However, to date, the ideal surgical approach for inguinal hernia surgery. The investigators
 therefore, propose a randomized controlled trial comparing laparoscopic inguinal hernia
 surgery repair to robotic inguinal hernia repair surgery.

 The investigators hypothesize that the robotic approach to inguinal hernia repair will result
 in improved post-operative outcomes compared to traditional laparoscopic inguinal hernia
 repairs.

 Specific Aim #1: To determine if the robotic approach will result in a significant reduction
 in postoperative pain and earlier return to full function when compared to a laparoscopic
 inguinal hernia repair.

 Specific Aim #2: To perform a cost analysis to determine the financial implications of
 performing a robotic versus a laparoscopic inguinal hernia repair.

 Specific Aim #3: To determine the effect of surgeon reported ergonomics when performing
 laparoscopic versus robotic inguinal hernia repairs.

 Specific Aim #4: Evaluate the long term hernia recurrence rates associated with laparoscopic
 versus robotic inguinal hernia repairs.
Inguinal hernia repair is the most commonly performed general surgery procedure in the United
 States. Despite the prevalence of this procedure, there is no consensus regarding the optimal
 approach to this surgical procedure. Since the advent of the laparoscopic inguinal hernia
 repair in 1990, there is a growing body of research that has investigated the efficacy of
 this minimally invasive surgical approach. To date, the laparoscopic approach to inguinal
 hernia repair has proven beneficial in reducing post-operative pain and allowing for earlier
 return to normal activity versus the traditional open inguinal hernia repair. In addition,
 the laparoscopic approach to inguinal hernia repair has been advocated for recurrent inguinal
 hernia repairs and bilateral inguinal hernia repairs.

 Despite these advantages, however, there are several limitations of the laparoscopic inguinal
 hernia repair. Specifically, unstable camera platforms, two-dimensional imaging, rigid
 laparoscopic instruments, and poor surgeon ergonomics make the laparoscopic approach to
 inguinal hernia repair challenging. Furthermore, the learning curve associated with a
 laparoscopic inguinal hernia repair has been prohibitive for many surgeons. Finally, the
 laparoscopic approach to inguinal hernia repair often requires the utilization of some form
 of fixation device, such as surgical tacks, which have been associated with chronic pain,
 vascular injury, as well as increased overall cost of the operation. The robotic platform has
 been shown to help compensate for many of these short-comings of laparoscopic surgery as it
 provides three-dimensional imaging, improved instrument mobility, articulation, suturing
 capability (which allows for a more cost-effective procedure with decreased risk of
 post-operative chronic pain), and surgeon comfort. Because of these reasons, it is important
 to determine the specific advantages the robotic approach will provide for inguinal hernia
 repairs.

 The laparoscopic approach to inguinal hernia repair has proven beneficial in reducing
 post-operative pain and earlier returns to normal activity versus the traditional open
 inguinal hernia repair. However, the overall penetrance of laparoscopic inguinal hernia
 repair has remained consistently below 20% of all inguinal hernia procedures performed in the
 United States. The robotic platform provides several potential advantages over the
 laparoscopic inguinal hernia repair including three dimensional visualization, the ability to
 suture (rather than tack) the mesh, as well as the ability to suture the peritoneal defect
 closed. This technological platform could provide earlier adoption and proficiency for
 surgeons to perform a minimally invasive inguinal hernia repair with improved surgical
 outcomes. As more general surgeons begin to incorporate robotic surgery into their practice,
 the robotic platform might provide further improvements in the outcomes of minimally invasive
 inguinal hernia repair over even traditional laparoscopic inguinal hernia repair.

 The investigators propose a Randomized Clinical Trial comparing the robotic versus
 laparoscopic inguinal hernia repair techniques. The investigators hypothesize that the
 robotic approach to inguinal hernia repair will result in improved post-operative outcomes
 compared to traditional laparoscopic inguinal hernia repairs.

 Specific Aim #1: To determine if the robotic approach will result in a significant reduction
 in postoperative pain and earlier return to full function when compared to a laparoscopic
 inguinal hernia repair.

 Specific Aim #2: To perform a cost analysis to determine the financial implications of
 performing a robotic versus a laparoscopic inguinal hernia repair.

 Specific Aim #3: To determine the effect of surgeon reported ergonomics when performing
 laparoscopic versus robotic inguinal hernia repairs.

 Specific Aim #4: Evaluate the long term hernia recurrence rates associated with laparoscopic
 versus robotic inguinal hernia repairs.
Inclusion Criteria:

 1. 21 years or older

 2. No prior open abdominal surgery at or below the umbilicus

 3. Primary or recurrent unilateral inguinal hernia repair

 4. No previous preperitoneal mesh placement

 5. BMI less than or equal to 40kg/m2

 Exclusion Criteria:

 1. Need for an open inguinal hernia repair

 2. Patients presenting for evaluation of bilateral inguinal hernias

 3. Patients requiring surgical repair of a strangulated inguinal hernia

 4. Patients with liver disease defined by the presence of ascites

 5. Patients with end-stage renal disease requiring dialysis

 6. Patients who are unable to give informed consent.