Open versus robotic transversus abdominis release for ventral hernia repair: an updated systematic review and meta-analysis.

BACKGROUND: While robotic transversus abdominis release (rTAR) offers distinct advantages over the open technique (oTAR) for complex ventral hernia repairs (VHR), its adoption rate lags behind. Despite superior peri- and postoperative outcomes, oTAR remains more widely utilized. The aim of this study is to conduct an updated systematic review and meta-analysis comparing rTAR and oTAR approaches for ventral hernia repair (VHR) patients. METHODS: PubMed, Cochrane, Embase and Web of Sciences were systematically searched from inception to February 2026 to identify randomized controlled trials and observational studies comparing rTAR versus oTAR for VHR. Meta-analyses were performed using a DerSimonian-Laird random-effects model, and statistical heterogeneity was assessed using Cochran's Q test and the I² statistic. All analyses were conducted in R (version 4.4.0). RESULTS: A total of 1,363 references were initially yielded, of whom only 10 observational studies, comprising 1,085 patients, 461 oTAR and 624 rTAR, were included in the analysis. The mean age was 62.3 years in the robotic group and 59.7 years in the open group. The mean BMI was 31.7 kg/m² in the robotic group and 31.4 kg/m² in the open group. Females comprised approximately 56% of the robotic cohort and 57% of the open cohort. The analysis showed that rTAR was associated with a statistically significant reduction in the SSO (OR 0.48; 95%CI 0.28 to 0.80; p-value = 0.004; I² = 15.4%), SSI (OR 0.27; 95%CI 0.13 to 0.55; p-value = 0.0003 I² = 0%) and readmission (OR 0.39; 95%CI 0.20 to 0.75; p-value = 0.004; I² = 0%) rates, being also associated with a statistically significant decrease in the mean LOS time (MD -4.65 days; 95%CI -5.65 to -3.66; p-value < 0.001; I² = 64.8%). However the implementation of rTAR was associated with a significant increase in operation time (MD 42.64 min; 95%CI 9.30 to 75.98; p-value = 0.012; I²= 83.4%) and no statistically significant difference was found regarding the recurrence rates (OR 0.89; 95%CI 0.30 to 2.63; p-value = 0.829; I² = 0%). CONCLUSION: Current observational data suggests that rTAR may offer a decreased odds of SSO, SSI, readmission rate and LOS when compared with oTAR. However, rTAR was associated with increased operative time.