ROGER Trial- BJS Feb.26

The ROGER randomised clinical trial compared robotic transabdominal preperitoneal repair (rTAPP) with laparoscopic totally extraperitoneal repair (TEP) for elective primary inguinal hernia.

In this single-centre, patient- and investigator-blinded Swiss RCT, 182 patients were randomised 1:1 (mostly male, mean age ~56 years, BMI ~25 kg/m²). The primary endpoint was postoperative pain while coughing at 24 hours.

Results showed no significant difference in pain between approaches (median score 5 for TEP vs 4 for rTAPP, P = 0.431). Postoperative complication rates were also similar (11% vs 10%).

However, key differences emerged:

Operating time was significantly longer with rTAPP (80 vs 64 minutes for unilateral repairs).

Surgeon workload, measured using the NASA Task Load Index, was substantially lower with rTAPP (mean 18 vs 34, P < 0.001).

Thus, while robotic repair did not improve early postoperative pain or reduce complications, it significantly reduced perceived surgical workload—at the cost of longer operative time.

Clinical takeaway: For patients, outcomes are equivalent. For surgeons, robotics may improve ergonomics and reduce fatigue. The decision to adopt robotic repair may therefore depend more on institutional resources and surgeon factors than on short-term patient benefit.