{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T06:16:12Z","timestamp":1788243372384,"version":"build-2803163510"},"reference-count":26,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background\/Objectives: Robotic-assisted abdominal wall reconstruction is increasingly used for ventral hernias; however, implementation in low-volume settings and early adoption of technically complex cases remain controversial. This study aimed to evaluate perioperative outcomes of robotic ventral hernia repair with early inclusion of technically complex cases and to compare these results with open surgery. Methods: Prospectively collected data were retrospectively analyzed for consecutive technically complex robotic ventral hernia repairs performed between September 2021 and December 2025. A cohort of consecutive open Rives\u2013Stoppa repairs was included for comparison (n = 21 per group). Outcomes included operative time, length of hospital stay (LOS), and perioperative complications. Results: Operative time was significantly longer in the robotic group (median 310 vs. 118 min, p &lt; 0.001). The median LOS was significantly shorter following robotic repair (3 vs. 5 days, p = 0.0018). Postoperative complications occurred in 10% of robotic cases and 24% of open cases (p = 0.41). Major complications and reoperation rates were low and comparable between groups. Technically complex robotic cases, including procedures requiring component separation, were introduced early and were associated with acceptable short-term outcomes. Conclusions: Technically complex robotic hernia repair was associated with significantly shorter hospital stay compared with open surgery, despite longer operative times and higher procedural complexity. Complication rates were comparable between groups. Early inclusion of technically complex cases was not associated with a statistically significant increase in short-term complications.<\/jats:p>","DOI":"10.3390\/jcm15176778","type":"journal-article","created":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T05:45:13Z","timestamp":1788241513000},"page":"6778","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Early Adoption of Technically Complex Robotic Ventral Hernia Repair in a Low-Volume Center: A Retrospective Comparative Analysis with Consecutive Open Cases"],"prefix":"10.3390","volume":"15","author":[{"given":"Andra\u017e","family":"Hubad","sequence":"first","affiliation":[{"name":"Department of Abdominal Surgery, University Medical Centre Ljubljana, Zalo\u0161ka cesta 7, 1000 Ljubljana, Slovenia"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1063-8636","authenticated-orcid":false,"given":"Ale\u0161","family":"Toma\u017ei\u010d","sequence":"additional","affiliation":[{"name":"Department of Abdominal Surgery, University Medical Centre Ljubljana, Zalo\u0161ka cesta 7, 1000 Ljubljana, Slovenia"},{"name":"Faculty of Medicine, University of Ljubljana, Korytkova 2, 1000 Ljubljana, Slovenia"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0791-2083","authenticated-orcid":false,"given":"Bla\u017e","family":"Trotov\u0161ek","sequence":"additional","affiliation":[{"name":"Department of Abdominal Surgery, University Medical Centre Ljubljana, Zalo\u0161ka cesta 7, 1000 Ljubljana, Slovenia"},{"name":"Faculty of Medicine, University of Ljubljana, Korytkova 2, 1000 Ljubljana, Slovenia"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"given":"Primo\u017e","family":"Sever","sequence":"additional","affiliation":[{"name":"Department of Abdominal Surgery, University Medical Centre Ljubljana, Zalo\u0161ka cesta 7, 1000 Ljubljana, Slovenia"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9832-4596","authenticated-orcid":false,"given":"Jan","family":"Grosek","sequence":"additional","affiliation":[{"name":"Department of Abdominal Surgery, University Medical Centre Ljubljana, Zalo\u0161ka cesta 7, 1000 Ljubljana, Slovenia"},{"name":"Faculty of Medicine, University of Ljubljana, Korytkova 2, 1000 Ljubljana, Slovenia"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"investigation","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,1]]},"reference":[{"key":"ref_1","first-page":"25","article-title":"Posterior component separation\/transversus abdominis release","volume":"6","author":"Siegal","year":"2019","journal-title":"Plast. Aesthet. Res."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1732","DOI":"10.1093\/bjs\/znad284","article-title":"Midline incisional hernia guidelines: The European Hernia Society","volume":"110","author":"Sanders","year":"2023","journal-title":"Br. J. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"K\u00f6ckerling, F. (2019). Recurrent incisional hernia repair\u2014An overview. Front. Surg., 6.","DOI":"10.3389\/fsurg.2019.00026"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1089\/lap.2016.0095","article-title":"Current Status and Challenges of Laparoscopy in Ventral Hernia Repair","volume":"26","author":"Tobler","year":"2016","journal-title":"J. Laparoendosc. Adv. Surg. Tech. A"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"7466","DOI":"10.1007\/s00464-024-11202-1","article-title":"Open versus robotic retromuscular ventral hernia repair: Outcomes of the ORREO prospective randomized controlled trial","volume":"38","author":"Warren","year":"2024","journal-title":"Surg. Endosc."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1007\/s00104-021-01479-6","article-title":"Robotic hernia repair II. English version: Robotic primary ventral and incisional hernia repair (rv-TAPP and r-Rives or r-TARUP). Video report and results of a series of 118 patients","volume":"92","author":"Baur","year":"2021","journal-title":"Chirurg"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1471","DOI":"10.1007\/s10029-021-02487-5","article-title":"Transversus abdominis release (TAR) for ventral hernia repair: Open or robotic? Short-term outcomes from a systematic review with meta-analysis","volume":"25","author":"Bracale","year":"2021","journal-title":"Hernia"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Choi, Y.S., Kim, K.D., Choi, M.S., Heo, Y.S., Yi, J.W., and Choe, Y.-M. (2023). Initial experience of robot-assisted transabdominal preperitoneal (TAPP) inguinal hernia repair by a single surgeon in South Korea. Medicina, 59.","DOI":"10.3390\/medicina59030582"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1131","DOI":"10.1007\/s10029-022-02730-7","article-title":"Comparison of short-term outcomes of robotic and laparoscopic transabdominal peritoneal repair for unilateral inguinal hernia: A propensity-score matched analysis","volume":"27","author":"Okamoto","year":"2023","journal-title":"Hernia"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"535","DOI":"10.1007\/s11701-026-03482-7","article-title":"Learning curve of robotic-assisted transabdominal preperitoneal inguinal hernia repair (r-TAPP): A scoping review of CUSUM-based studies","volume":"20","author":"Brucchi","year":"2026","journal-title":"J. Robot. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"756","DOI":"10.1089\/lap.2020.0624","article-title":"Learning Curve of Robotic Rives-Stoppa Ventral Hernia Repair: A Cumulative Sum Analysis","volume":"31","author":"Kudsi","year":"2021","journal-title":"J. Laparoendosc. Adv. Surg. Tech. A"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"3480","DOI":"10.1007\/s00464-021-08669-7","article-title":"Learning curve of robotic transversus abdominis release in ventral hernia repair: A cumulative sum (CUSUM) analysis","volume":"36","author":"Kudsi","year":"2022","journal-title":"Surg. Endosc."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Vierstraete, M., Simons, M., Borch, K., de Beaux, A., East, B., Reinpold, W., Stabilini, C., and Muysoms, F. (2022). Description of the current Da Vinci\u00ae training pathway for robotic abdominal wall surgery by the European Hernia Society. J. Abdom. Wall Surg., 1.","DOI":"10.3389\/jaws.2022.10914"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Latif, J., Brazkiewicz, M., Inan, I., Muysoms, F., Bhatti, I., and Awan, A. (2025). Outcomes During the Learning Curve and Feasibility of Implementing the European Hernia Society Recommendation Guidelines for Robotic Abdominal Wall Surgery Within a UK Centre. J. Abdom. Wall Surg., 4.","DOI":"10.3389\/jaws.2025.15008"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Anton, J., Maertens, V., Melsens, E., Verrelst, L., Van Kerschaver, O., and Fierens, K. (2026). Introducing robotic surgery in a low-volume, community hospital: Outcomes of the first 50 ventral hernia repairs (TARUP). J. Abdom. Wall Surg., 5.","DOI":"10.3389\/jaws.2026.15942"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1007\/s11701-025-02220-9","article-title":"Long-term outcomes of robotic inguinal hernia repair (r-TAPP): A retrospective review of 434 consecutive cases by a single surgeon with 3\u20138 years of follow-up","volume":"19","author":"Viera","year":"2025","journal-title":"J. Robot. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1205","DOI":"10.1007\/s10029-024-03006-y","article-title":"Economic analysis of the robotic approach to inguinal hernia versus laparoscopic: Is it sustainable for the healthcare system?","volume":"28","author":"Agua","year":"2024","journal-title":"Hernia"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1007\/s11701-026-03335-3","article-title":"Short-term outcomes of robotic versus laparoscopic TAPP for inguinal hernia repair: A systematic review, meta-analysis, and GRADE assessment","volume":"20","author":"Zidan","year":"2026","journal-title":"J. Robot. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Henriksen, N., Christoffersen, M.W., Marckmann, M., and Jensen, K.K. (2025). Procedural Costs of Robot-Assisted and Laparoscopic Ventral and Incisional Hernia Repair: A Propensity-Score Matched Nationwide Database Study. J. Abdom. Wall Surg., 4.","DOI":"10.3389\/jaws.2025.15464"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1007\/s10029-013-1168-6","article-title":"Criteria for definition of a complex abdominal wall hernia","volume":"18","author":"Slater","year":"2014","journal-title":"Hernia"},{"key":"ref_21","first-page":"e60181","article-title":"Exploring variable approaches in complex hernia repair: A comprehensive literature review","volume":"16","year":"2024","journal-title":"Cureus"},{"key":"ref_22","first-page":"e20243670","article-title":"Predictive factors for complexity in abdominal wall hernias: A literature scope review","volume":"51","author":"Barbosa","year":"2024","journal-title":"Rev. Col. Bras. Cir."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"znad346","DOI":"10.1093\/bjs\/znad346","article-title":"What defines an incisional hernia as \u2018complex\u2019: Results from a Delphi consensus endorsed by the European Hernia Society (EHS)","volume":"111","author":"Podda","year":"2024","journal-title":"Br. J. Surg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"8086","DOI":"10.1038\/s41598-021-86093-6","article-title":"Comparisons of abdominal wall reconstruction for ventral hernia repairs, open versus robotic","volume":"11","author":"Nguyen","year":"2021","journal-title":"Sci. Rep."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1007\/s10029-025-03274-2","article-title":"Systematic review and meta-analysis on robotic assisted ventral hernia repair: The ROVER review","volume":"29","author":"Vierstraete","year":"2025","journal-title":"Hernia"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"7083","DOI":"10.1007\/s00464-024-11382-w","article-title":"Open versus robotic transversus abdominis release for ventral hernia repair: An updated systematic review, meta-analysis, and meta-regression","volume":"38","author":"Lima","year":"2024","journal-title":"Surg. Endosc."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/17\/6778\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T05:59:33Z","timestamp":1788242373000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/17\/6778"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,1]]},"references-count":26,"journal-issue":{"issue":"17","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["jcm15176778"],"URL":"https:\/\/doi.org\/10.3390\/jcm15176778","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,1]]}}}