First United States experience of robotic-assisted minimally invasive inguinal hernia repair using the Dexter surgical system

BACKGROUND: Robotic-assisted inguinal hernia repair continues to evolve with the introduction of novel surgical platforms designed to improve costs, workflow integration, and ergonomics. The Dexter Surgical System has recently entered clinical practice; however, its use for inguinal hernia repair in the USA has not been reported. This study evaluated feasibility, safety, and early operative outcomes in a United States cohort. METHODS: A retrospective review was conducted of consecutive patients undergoing robotic inguinal hernia repair with Dexter at a single academic center between November 2024 and November 2025. Primary outcomes included intraoperative complications, device-related adverse events, and conversion to open or laparoscopic surgery. Secondary outcomes included operative time, console time, docking time, length of stay, and 30-day outcomes. Learning curve analysis was performed using cumulative sum methodology, along with a comparison of the primary surgeon's first five versus final five cases. RESULTS: Twenty-six patients underwent robotic inguinal hernia repair performed by two fellowship-trained minimally invasive surgeons with extensive prior robotics experience. All procedures were completed without conversion, complications, or device-related events, and all patients were discharged the same day. Mean operative time was 63.1 ± 18.5 min, with mean console time of 38.5 ± 15.7 min and docking time of 6.1 ± 2.2 min. One patient (3.8%) developed postoperative pneumonia requiring admission and intravenous antibiotics; no other 30-day complications, readmissions, or reoperations occurred. CUSUM analysis identified an inflection point at case six, after which operative times trended below the mean. Mean operative time decreased from 66.8 ± 11.1 min in the first five cases to 54.0 ± 13.3 min in the final five. CONCLUSION: This first United States experience demonstrates that robotic inguinal hernia repair using Dexter is feasible and safe in the outpatient setting, with favorable outcomes, efficient operative times, and a rapid learning curve among experienced surgeons.