Implementation of robot-assisted transabdominal preperitoneal inguinal hernia repair: A prospective cohort study

BACKGROUND: Robotic-assisted transabdominal preperitoneal repair (rTAPP) is increasingly used for inguinal hernia. However, evidence on its implementation in district hospitals and its integration into resident training programs remains limited. The aim of this study was to assess a real-world implementation of rTAPP in a public district hospital. METHODS: Patients with inguinal hernia who underwent rTAPP between May 2024 and May 2025 were included. Perioperative outcomes, quality of life (QoL), and recurrence within the first 6 months were assessed. Implementation was analyzed across three consecutive phases to evaluate changes in operative performance and trainee involvement. QoL was measured using the 5-level EQ-5D version (EQ-5D-5L) in a subset of patients with available pre- and postoperative data. RESULTS: A total of 120 patients underwent rTAPP. There were no conversions to laparoscopic or open surgery. Postoperative complications were observed in 8 (6.7%) patients and were limited to Accordion grade I-II events. The median length of postoperative stay was 20 h. One patient (0.8%) experienced hernia recurrence within 6 months. In contrast with phase 1, resident surgeons performed rTAPP in phases 2 (15%) and 3 (12.5%). Mean operative time decreased from 86 min in phase 1 to 74 and 77 min in phases 2 and 3, respectively (p = 0.041) without a significant difference in postoperative complications. Paired EQ-5D-5L data demonstrated significant postoperative improvement in pain/discomfort, daily activities, and overall health score. CONCLUSION: Robotic-assisted inguinal hernia repair can be safely implemented in a district hospital setting with favorable short-term outcomes. Structured introduction of rTAPP allowed rapid involvement of surgeons without compromising perioperative safety or efficiency.