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Invited Commentary
October 21, 2020

The Robot in General Surgery—Change Is the Only Constant

Author Affiliations
  • 1Department of Surgery, Emory University, Atlanta, Georgia
JAMA Surg. 2021;156(1):30. doi:10.1001/jamasurg.2020.4590

We applaud Petro et al1 for presenting randomized clinical data evaluating the use of the robotic platform in ventral hernia repair in the Laparoscopic vs Robotic Ventral Hernia Repair With IPOM (PROVE-IT) trial. The trial found no difference in pain, complications, length of stay, or quality of life between randomized patients undergoing robotic vs laparoscopic ventral hernia repair with intraperitoneal mesh placement (IPOM), but did find a significantly increased operative time in the robotic ventral hernia repair group, directly increasing cost.1 These results are paired with the multi-institutional Role of the Robotic Platform in Inguinal Hernia Repair Surgery (RIVAL) trial2 published in March 2020 by some of the same authors, wherein patients were prospectively randomized to robotic vs laparoscopic transabdominal preperitoneal inguinal hernia repair with mesh. The RIVAL trial also revealed no clinical benefit with the robotic approach but found increased cost, increased surgeon frustration, and, curiously, worse surgeon ergonomics while using the robot.

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