Abstract
BACKGROUND: Ventral hernia repair (VHR) is a common general surgical procedure. While robotic VHR (RVHR) has shown advantages in large, complex hernias, comparative evidence with laparoscopic VHR (LVHR) for smaller defects is limited. METHODS: We conducted a prospective, real-world evidence study across 12 centers in India. Adults aged 18–65 years undergoing primary or incisional VHR with a defect ≤ 5 cm requiring mesh placement were included. Primary outcomes were postoperative pain and analgesic use within 14 days; secondary outcomes included quality of life (QoL), hospital stay, and perioperative complications. RESULTS: A total of 200 patients (101 RVHR, 99 LVHR) were analyzed, with comparable baseline characteristics. Defect size was larger in the RVHR group (p < 0.001). Median operative time was longer in RVHR (p < 0.001), while post-anesthesia care unit stay was shorter (p = 0.0026). RVHR was associated with faster recovery, including earlier return to daily activities (median 5 vs. 7 days, p < 0.001), fewer analgesic doses (2.55 ± 0.97 vs. 3.25 ± 1.55, p < 0.001), and shorter work restrictions (14 vs. 30 days, p = 0.0042). Pain outcomes favored RVHR, with consistently lower Numeric Rating Scale (NRS) scores, greater improvement in PROMIS pain intensity scores at day 14 (p = 0.0072), and more patients reporting low pain intensity (51.5% vs. 27.4%, p = 0.001). QoL improved significantly in RVHR, with higher EQ-5D-3L index and VAS gains at day 14 and 30 (all p < 0.01). Complication rates were low and comparable. CONCLUSION: Compared with LVHR, RVHR offered faster recovery, less pain, reduced analgesic use, and better early QoL, supporting its feasibility and short-term advantages.