Robotic-assisted abdominal wall reconstruction: A systematic review of techniques, outcomes, and future directions

This systematic review exhaustively reviews the use of robotic-assisted abdominal wall reconstruction (AWR) in cases of ventral hernias and abdominal wall defects, by synthesizing the evidence on surgical technique, clinical outcomes and research future directions to determine efficacy, safety and patient-centered efficacy of robotic-assisted over the traditional open and laparoscopic procedures and what technological innovations and areas of knowledge remain unknown to improve clinical care and future research. There has been an increased rate of adoption of robotic-assisted AWR with sophisticated platforms such as the da Vinci Surgical System providing better visualization, precision, and dexterity. This review focuses on transabdominal preperitoneal (TAPP), totally extraperitoneal (TEP), retro rectus repair, and component separation techniques, which have been analyzed over the years between 2010 and 2025. The most notable results are suggesting that robotic AWR is related to a shorter time of postoperative pain, shorter hospital stay (mean 2-4 days vs. 5-7 days following open surgery), and equal or lesser hernia recurrence (3-8% at 2 years) than laparoscopic (5-10%) and open surgeries (10-15%). The rates of complications, such as seroma (5 to 10 percent) and surgical site infections (25 percent), are compared unfavorably with open surgery (15 to 20 percent). The new developments include artificial intelligence for intraoperative guidance, single-port robotics, and novel biomaterials used in mesh. Nevertheless, high expenses (ranging from $1.5 to $2 million for robotic systems) and an enormous learning curve (requiring 50 to 100 cases to master) are significant obstacles. Future studies should focus on long-term outcomes (greater than 5 years), cost-effectiveness evaluations, and standard training procedures to enhance accessibility.