Robotic-Assisted Versus Open Transversus Abdominis Release (TAR) for Complex Ventral Hernia Repair: A Systematic Review and Meta-Analysis

Transversus abdominis release (TAR) is an effective posterior component separation technique for complex ventral hernia repair.While open TAR (oTAR) is the standard procedure, robotic-assisted TAR (rTAR) has emerged to mitigate the substantial wound morbidity associated with large abdominal incisions.This systematic review and meta-analysis aimed to evaluate the comparative effectiveness and safety of rTAR and oTAR.A systematic search of PubMed/MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Scopus, and Web of Science was conducted until August 2026.Studies comparing rTAR and oTAR in adults were included.The primary outcomes were overall complications, surgical site occurrences (SSOs), surgical site infections (SSIs), length of hospital stay (LOS), and hernia recurrence rates.Random-effects meta-analyses were performed, and the certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework.Twelve observational studies encompassing 1,651 patients (605 rTAR, 1,046 oTAR) met the inclusion criteria, with 10 studies providing data for quantitative synthesis (n=1,407).Compared with oTAR, rTAR was associated with a statistically significant reduction in overall postoperative complications (OR 0.48; 95% CI 0.34-0.68;p<0.001),SSOs (OR 0.43; 95% CI 0.25-0.75;p=0.003), and SSIs (OR 0.45; 95% CI 0.21-0.96;p=0.038).rTAR significantly reduced LOS (MD -3.76 days; 95% CI -4.68 to -2.84; p<0.001) and estimated blood loss (MD -107.44 mL; p<0.001), although it required significantly longer operative times (MD +53.62 min; p<0.001).In an exploratory subgroup analysis, the SSI reduction was observed with pure robotic techniques (OR 0.24) but not with hybrid approaches, which were represented by only two potentially overlapping studies.Data on long-term recurrence and patient-reported outcomes are sparse.Due to the observational nature of the included studies and inherent selection bias, the overall certainty of the evidence was rated as low to very low.rTAR is associated with perioperative advantages over oTAR, decreasing wound morbidity, overall complications, and LOS, albeit at the expense of longer operative times.Pure rTAR may offer greater wound benefit; however, high-quality randomized controlled trials are required to assess long-term hernia recurrence and cost-effectiveness.