Robotic surgery enables effective and safe repair of hard-to-reach abdominal hernias: Study

In one of the largest studies of its kind, surgeons successfully completed 39 complex lateral abdominal wall hernia repairs using robotic surgery, without converting any procedure to open surgery. Most patients returned home after just one day, and no hernias recurred during a median follow-up of approximately 14 months. The approach may offer an important improvement over conventional techniques by giving surgeons greater precision and flexibility in a particularly difficult-to-reach area, while enabling smaller incisions, low postoperative pain, and faster recovery.

Surgeons have shown that robotic technology can help repair a rare and difficult type of hernia that develops along the side of the abdomen. These hernias are hard to treat because they form near the ribs, pelvis, muscles, nerves, and blood vessels.

In a new study published in Hernia, researchers examined 39 robotic hernia repairs performed between 2018 and 2025.

• All 39 operations were completed robotically, without converting to open or conventional keyhole surgery.
• Most patients went home after just one day.
• No hernias returned during a median follow-up of approximately 14 months.

“Robotic technology is changing the boundaries of what surgeons can do through small incisions,” said Dr. Freund. “In this case, it allowed us to reach one of the most unforgiving parts of the abdominal wall, an area surrounded by bone, muscle, nerves, and blood vessels, and rebuild the abdominal wall with remarkable precision. It transforms how we can approach an operation that has traditionally been exceptionally difficult.”

The study was led by Dr. Michael Freund of the Hebrew University and Shaare Zedek Medical Center under the guidance of Prof. David Hazzan of Raphael Hospital in collaboration with Sheba Medical Center and Tel Aviv University.

A difficult hernia to repair

A hernia occurs when tissue or part of an organ pushes through a weak area in the abdominal wall. Lateral abdominal wall hernias form along the side of the body, rather than in the groin or middle of the abdomen.

Their location gives surgeons little room to work or position the mesh used to strengthen the abdominal wall. Previous operations can make the repair even harder by leaving scar tissue and changing the normal anatomy.

Most patients in the study developed their hernias at the site of an earlier operation, including kidney, colorectal, spinal, or gallbladder surgery.

What the robot changes

Open surgery can require a large incision and a longer recovery. Conventional keyhole surgery uses smaller incisions, but its rigid instruments can be difficult to move at the angles needed to repair a hernia along the side of the body.

Robotic instruments bend and rotate much like a human wrist. They also give the surgeon a magnified, three-dimensional view of the area.

This makes it easier to reach the hernia, close the opening, and place a large piece of reinforcing mesh behind the muscle, where tissue separates it from the internal organs.

In another recent study of hernias located away from the center of the abdomen, some procedures had to be partly converted to open surgery, complications occurred in around one-third of patients, and some hernias returned. In the new Israeli study, every operation was completed robotically and no hernias returned during the follow-up period. The researchers note, however, that the studies involved different patients and cannot be directly compared.

“We are entering a new era in which even highly complex operations can be performed with greater precision and far less disruption to the patient,” said Prof. Hazzan. “In our study, every procedure was completed robotically, most patients returned home after just one day, and no hernias returned during follow-up. These are early results, but they offer a powerful glimpse of how robotic surgery could reshape complex abdominal reconstruction.”

Encouraging early results

Most patients recovered without complications and reported little pain after surgery. Two developed bowel obstructions and needed another laparoscopic procedure, but both recovered without having any part of the bowel removed.

The researchers caution that this was a relatively small retrospective study and did not directly compare robotic surgery with other methods. Patients will also need to be followed for longer to determine whether the repairs remain successful over many years.

Even so, this is one of the largest studies focused specifically on robotic repair of lateral abdominal wall hernias. The findings suggest that robotic technology may make these difficult operations more precise and less invasive, while helping patients return home sooner.

Reference:

Freund, M.R., Katz, E., Lahav, L. et al. Robotic TAPP repair of lateral abdominal wall hernias: a multi-center experience. Hernia 30, 329 (2026). https://doi.org/10.1007/s10029-026-03835-z