Mishal Javed,Jesse Kigozi,Catherine A Moakes,Gareth R Bate,Jack A Hall,Jon J Deeks,Lisa Kelly,Lewis Meecham,Andrew W Bradbury,Matthew A Popplewell,
BACKGROUNDThe BASIL-3 trial demonstrated that patients with chronic limb-threatening ischaemia secondary to femoropopliteal disease who were randomized to plain balloon angioplasty (PBA) ± bare-metal stenting (BMS), drug-coated balloon angioplasty (DCBA) ± BMS, or drug-eluting stenting (DES) had similar clinical outcomes. Herein, the in-trial health economic analysis is presented.METHODSCost-utility analysis (CUA) and cost-effectiveness analysis (CEA) were conducted from the perspective of the UK National Health Service (NHS) and Personal Social Services Research Unit. Patient-level resource use and health outcome data were collected from the BASIL-3 trial during 2-7 years of follow-up and were utilized to estimate incremental cost-effectiveness ratios expressed as a cost per amputation-free life-year and per quality-adjusted life-year (QALY). EQ-5D-5L was used to generate participant QALYs at baseline and during follow-up.RESULTSIn the CUA, DCBA was associated with slightly lower NHS costs (-£250.71 (95% c.i. -£4630.34 to £3652.10)), but slightly lower QALY gains (-0.007 (95% c.i. -0.116 to 0.097) QALYs) when compared with PBA. When compared with PBA, DES was less costly (-£724.52 (95% c.i. -£4975.04 to £2631.57)) and resulted in an additional 0.048 (95% c.i. -0.060 to 0.148) QALYs.CONCLUSIONIn BASIL-3, the probability of DCBA and of DES being cost-effective at £20 000 per QALY was 52% and 76% respectively. At a higher willingness-to-pay threshold (£30 000 per QALY) DES may be cost-effective and further research is required to explore the economic case.
BASIL-3试验表明，随机分为普通球囊血管成形术（PBA）±裸金属支架植入术（BMS）、药物包被球囊血管成形术（DCBA）±BMS或药物洗脱支架植入术（DES）的股腘动脉疾病继发慢性肢体威胁性缺血患者具有相似的临床结果。在此，提出了试验中的卫生经济分析。方法从英国国家卫生服务体系（NHS）和个人社会服务研究单位的角度进行成本-效用分析（CUA）和成本-效果分析（CEA）。在2-7年的随访期间，从BASIL-3试验中收集了患者水平的资源使用和健康结果数据，并用于估计增量成本-效果比，以每个无截肢生命年和每个质量调整生命年（QALY）的成本表示。EQ-5D-5L用于在基线和随访期间生成参与者的QALYs。结果在CUA中，与PBA相比，DCBA与略低的NHS成本(- 250.71英镑（95% ci - 4630.34英镑至3652.10英镑）相关，但与PBA相比，QALY收益略低（-0.007英镑（95% ci -0.116英镑至0.097英镑）QALY）。与PBA相比，DES的成本更低（- 724.52英镑（95% c.i. - 4975.04英镑至2631.57英镑）），质量年增加0.048英镑（95% c.i. -0.060英镑至0.148英镑）。结论在BASIL-3中，DCBA和DES的成本效益概率分别为52%和76%，每个QALY为20,000英镑。在较高的支付意愿门槛（每个QALY 30,000英镑）下，DES可能具有成本效益，需要进一步研究以探索经济案例。
{"title":"Plain balloon angioplasty with or without bare-metal stenting versus drug-coated balloon angioplasty with or without bare-metal stenting versus primary drug-eluting stenting in patients requiring femoropopliteal, with or without infrapopliteal, endovascular revascularization for chronic limb-threatening ischaemia: BASIL-3 within-trial health economic analysis.","authors":"Mishal Javed,Jesse Kigozi,Catherine A Moakes,Gareth R Bate,Jack A Hall,Jon J Deeks,Lisa Kelly,Lewis Meecham,Andrew W Bradbury,Matthew A Popplewell, ","doi":"10.1093/bjs/znaf274","DOIUrl":"https://doi.org/10.1093/bjs/znaf274","url":null,"abstract":"BACKGROUNDThe BASIL-3 trial demonstrated that patients with chronic limb-threatening ischaemia secondary to femoropopliteal disease who were randomized to plain balloon angioplasty (PBA) ± bare-metal stenting (BMS), drug-coated balloon angioplasty (DCBA) ± BMS, or drug-eluting stenting (DES) had similar clinical outcomes. Herein, the in-trial health economic analysis is presented.METHODSCost-utility analysis (CUA) and cost-effectiveness analysis (CEA) were conducted from the perspective of the UK National Health Service (NHS) and Personal Social Services Research Unit. Patient-level resource use and health outcome data were collected from the BASIL-3 trial during 2-7 years of follow-up and were utilized to estimate incremental cost-effectiveness ratios expressed as a cost per amputation-free life-year and per quality-adjusted life-year (QALY). EQ-5D-5L was used to generate participant QALYs at baseline and during follow-up.RESULTSIn the CUA, DCBA was associated with slightly lower NHS costs (-£250.71 (95% c.i. -£4630.34 to £3652.10)), but slightly lower QALY gains (-0.007 (95% c.i. -0.116 to 0.097) QALYs) when compared with PBA. When compared with PBA, DES was less costly (-£724.52 (95% c.i. -£4975.04 to £2631.57)) and resulted in an additional 0.048 (95% c.i. -0.060 to 0.148) QALYs.CONCLUSIONIn BASIL-3, the probability of DCBA and of DES being cost-effective at £20 000 per QALY was 52% and 76% respectively. At a higher willingness-to-pay threshold (£30 000 per QALY) DES may be cost-effective and further research is required to explore the economic case.","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"3 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2026-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147350520","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Seonghye Kim,Kyung-Do Han,Jinhyung Jung,Yun-Mi Song,Jae-Hyun Park,Jong Ho Cho,Dong Wook Shin
INTRODUCTIONThere is little data on the occurrence of cardiovascular disease (CVD) in oesophageal cancer (OC) survivors. Risk of CVD was investigated as a composite of myocardial infarction (MI), atrial fibrillation (AF), heart failure (HF), and ischaemic stroke (IS), as well as CVD-specific death among OC survivors after surgery.METHODSA population-based retrospective cohort study was performed using the Korean National Health Insurance Service database (2009-2022), including patients who underwent surgery for OC (n = 3996) and 1:3 propensity score-matched non-cancer controls (n = 11 988).RESULTSA total of 3996 OC survivors and 11 988 non-cancer controls were included in this study. Among OC survivors and controls, 492 and 1599 incident CVD cases and 33 and 305 CVD-specific deaths were observed respectively. OC survivors showed a higher risk of CVD (cause-specific hazard ratio (csHR) 1.42, 95% c.i. 1.28 to 1.57) than controls, and patients who underwent chemoradiotherapy plus surgery were at the highest risk. The increased risk was most prominent within the first year after surgery (csHR 3.00, 95% c.i. 2.35 to 3.85), but persisted thereafter (csHR 1.23, 95% c.i. 1.10 to 1.38 at 1-year lag; csHR 1.23, 95% c.i. 1.08 to 1.40 at 3-year lag; csHR 1.34, 95% c.i. 1.14 to 1.57 at 5-year lag). This pattern was evident for MI and AF, but not for HF, IS, or CVD-specific death.DISCUSSIONThere is an increased risk of CVD in OC survivors compared to controls. The risk of CVD varied by the outcome, treatment, and duration after surgery.
关于食管癌（OC）幸存者心血管疾病（CVD）发生的数据很少。心血管疾病的风险作为心肌梗死（MI）、心房颤动（AF）、心力衰竭（HF）和缺血性卒中（IS）的组合，以及心血管疾病特异性死亡在手术后OC幸存者中进行了调查。方法采用韩国国民健康保险服务数据库（2009-2022）进行基于人群的回顾性队列研究，包括接受手术治疗的OC患者（n = 3996）和1:3倾向评分匹配的非癌症对照组（n = 119888）。结果本研究共纳入3996例肺癌幸存者和11988例非癌对照。在OC幸存者和对照组中，分别观察到492例和1599例CVD事件和33例和305例CVD特异性死亡。癌症幸存者患CVD的风险高于对照组（病因特异性风险比（csHR） 1.42, 95% ci 1.28 ~ 1.57），接受放化疗加手术的患者风险最高。风险增加在手术后第一年最为显著（csHR 3.00, 95% ci . 2.35 ~ 3.85），但此后持续存在（csHR 1.23, 95% ci . 1.10 ~ 1.38, 1年滞后；csHR 1.23, 95% ci . 1.08 ~ 1.40, 3年滞后；csHR 1.34, 95% ci . 1.14 ~ 1.57, 5年滞后）。这种模式在心梗和房颤中很明显，但在心衰、IS或cvd特异性死亡中不明显。讨论：与对照组相比，卵巢癌幸存者患心血管疾病的风险增加。心血管疾病的风险因手术后的结果、治疗和持续时间而异。
{"title":"Retrospective population-based cohort study on the risk of cardiovascular disease among oesophageal cancer survivors.","authors":"Seonghye Kim,Kyung-Do Han,Jinhyung Jung,Yun-Mi Song,Jae-Hyun Park,Jong Ho Cho,Dong Wook Shin","doi":"10.1093/bjs/znaf264","DOIUrl":"https://doi.org/10.1093/bjs/znaf264","url":null,"abstract":"INTRODUCTIONThere is little data on the occurrence of cardiovascular disease (CVD) in oesophageal cancer (OC) survivors. Risk of CVD was investigated as a composite of myocardial infarction (MI), atrial fibrillation (AF), heart failure (HF), and ischaemic stroke (IS), as well as CVD-specific death among OC survivors after surgery.METHODSA population-based retrospective cohort study was performed using the Korean National Health Insurance Service database (2009-2022), including patients who underwent surgery for OC (n = 3996) and 1:3 propensity score-matched non-cancer controls (n = 11 988).RESULTSA total of 3996 OC survivors and 11 988 non-cancer controls were included in this study. Among OC survivors and controls, 492 and 1599 incident CVD cases and 33 and 305 CVD-specific deaths were observed respectively. OC survivors showed a higher risk of CVD (cause-specific hazard ratio (csHR) 1.42, 95% c.i. 1.28 to 1.57) than controls, and patients who underwent chemoradiotherapy plus surgery were at the highest risk. The increased risk was most prominent within the first year after surgery (csHR 3.00, 95% c.i. 2.35 to 3.85), but persisted thereafter (csHR 1.23, 95% c.i. 1.10 to 1.38 at 1-year lag; csHR 1.23, 95% c.i. 1.08 to 1.40 at 3-year lag; csHR 1.34, 95% c.i. 1.14 to 1.57 at 5-year lag). This pattern was evident for MI and AF, but not for HF, IS, or CVD-specific death.DISCUSSIONThere is an increased risk of CVD in OC survivors compared to controls. The risk of CVD varied by the outcome, treatment, and duration after surgery.","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"13 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2026-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147350928","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Chelsia Gillis,Daniel I McIsaac,Daniel Santa Mina,Stéphanie Chevalier,Gabriele Baldini,Francesco Carli,Celena Scheede-Bergdahl,Linda Edgar,Vanessa Smrk,Leah Avery,Amal Bessissow,Miquel Coca Martinez,Robert Copeland,Susanne Oksbjerg Dalton,Gerad Danjoux,Linda Denehy,Dominique Engel,Chloe Grimmett,Michael P Grocott,Heather L Gill,Sandy Jack,Bente Thoft Jensen,Denny Levett,Graciela Martinez-Palli,Zoe Merchant,John Moore,Nicolò Pecorelli,Ian Randall,Bernhard Riedel,Geoff Schierbeck,Gerrit Slooter,Malcolm West,Julio F Fiore,
BACKGROUNDPrehabilitation, a process of building physiological reserve before surgery to improve postoperative outcomes, is a complex, multimodal intervention that requires rigorous evaluation in clinical trials. Incomplete reporting by such trials obscures essential intervention components and delivery contexts, hindering comparability and interpretability. This, in turn, limits clinical implementation and the replication or refinement of interventions by researchers. The aim of this study was to develop a reporting checklist for RCTs of prehabilitation.METHODSA modified two-round Delphi process using the EQUATOR framework with 53 international experts across exercise, nutrition, psychological, and perioperative care disciplines was conducted. An initial checklist of candidate items was adapted from existing reporting standards, contextualized for prehabilitation, and iteratively refined through expert voting. Items rated eight to nine on a nine-point scale by ≥70% of participants in round two were classified as 'essential' and those rated seven were considered 'important'.RESULTSThe final checklist comprised 40 items. Sixteen items were classified as 'essential' and 24 items were classified as 'important' for guiding comprehensive reporting of prehabilitation interventions. These items span key domains including intervention components, delivery methods, adherence, participant characteristics, and outcome measures. High agreement among experts underscores the checklist's relevance and usability.CONCLUSIONAdoption of Standards for reporting research methods, interventions, and Outcomes in Surgical Prehabilitation studies (SOS-Prehab), alongside methodological and outcome-reporting items of CONSORT could improve transparency, completeness, and interpretability of prehabilitation trials. This could enable better reproducibility, robust evidence synthesis, and accelerate translation into clinical practice and policy.
{"title":"Standards for reporting research methods, interventions, and Outcomes in Surgical Prehabilitation studies (SOS-Prehab).","authors":"Chelsia Gillis,Daniel I McIsaac,Daniel Santa Mina,Stéphanie Chevalier,Gabriele Baldini,Francesco Carli,Celena Scheede-Bergdahl,Linda Edgar,Vanessa Smrk,Leah Avery,Amal Bessissow,Miquel Coca Martinez,Robert Copeland,Susanne Oksbjerg Dalton,Gerad Danjoux,Linda Denehy,Dominique Engel,Chloe Grimmett,Michael P Grocott,Heather L Gill,Sandy Jack,Bente Thoft Jensen,Denny Levett,Graciela Martinez-Palli,Zoe Merchant,John Moore,Nicolò Pecorelli,Ian Randall,Bernhard Riedel,Geoff Schierbeck,Gerrit Slooter,Malcolm West,Julio F Fiore, ","doi":"10.1093/bjs/znaf302","DOIUrl":"https://doi.org/10.1093/bjs/znaf302","url":null,"abstract":"BACKGROUNDPrehabilitation, a process of building physiological reserve before surgery to improve postoperative outcomes, is a complex, multimodal intervention that requires rigorous evaluation in clinical trials. Incomplete reporting by such trials obscures essential intervention components and delivery contexts, hindering comparability and interpretability. This, in turn, limits clinical implementation and the replication or refinement of interventions by researchers. The aim of this study was to develop a reporting checklist for RCTs of prehabilitation.METHODSA modified two-round Delphi process using the EQUATOR framework with 53 international experts across exercise, nutrition, psychological, and perioperative care disciplines was conducted. An initial checklist of candidate items was adapted from existing reporting standards, contextualized for prehabilitation, and iteratively refined through expert voting. Items rated eight to nine on a nine-point scale by ≥70% of participants in round two were classified as 'essential' and those rated seven were considered 'important'.RESULTSThe final checklist comprised 40 items. Sixteen items were classified as 'essential' and 24 items were classified as 'important' for guiding comprehensive reporting of prehabilitation interventions. These items span key domains including intervention components, delivery methods, adherence, participant characteristics, and outcome measures. High agreement among experts underscores the checklist's relevance and usability.CONCLUSIONAdoption of Standards for reporting research methods, interventions, and Outcomes in Surgical Prehabilitation studies (SOS-Prehab), alongside methodological and outcome-reporting items of CONSORT could improve transparency, completeness, and interpretability of prehabilitation trials. This could enable better reproducibility, robust evidence synthesis, and accelerate translation into clinical practice and policy.","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"45 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2026-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147454592","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tara Edwards,Gurinder Rayat,Denny Z H Levett,Malcolm A West
{"title":"Perioperative risk assessment with Cardiopulmonary exercise testing: supporting shared decision making and prehabilitation.","authors":"Tara Edwards,Gurinder Rayat,Denny Z H Levett,Malcolm A West","doi":"10.1093/bjs/znag020","DOIUrl":"https://doi.org/10.1093/bjs/znag020","url":null,"abstract":"","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"71 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2026-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147329482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Robotic mastectomy: the possibility of a scarless future.","authors":"Gordon R Daly,Jennifer L McGarry,Arnold D K Hill","doi":"10.1093/bjs/znag002","DOIUrl":"https://doi.org/10.1093/bjs/znag002","url":null,"abstract":"","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"32 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2026-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146021676","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Saving the surgeon-scientist: need to build enduring support for surgical science.","authors":"Noémie Villemure-Poliquin,Stephanie Wong,Julie Hallet","doi":"10.1093/bjs/znag003","DOIUrl":"https://doi.org/10.1093/bjs/znag003","url":null,"abstract":"","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"64 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2026-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146033618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Julien Hedou,Gwendoline Mendes,Grégoire Bellan,Daniel El Khoury,Franck Verdonk
{"title":"Impact of postoperative complications on cost and length of stay: multicentre prospective clinical study.","authors":"Julien Hedou,Gwendoline Mendes,Grégoire Bellan,Daniel El Khoury,Franck Verdonk","doi":"10.1093/bjs/znaf290","DOIUrl":"https://doi.org/10.1093/bjs/znaf290","url":null,"abstract":"","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"37 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145986563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Fiorenzo V Angehrn,Julian Süsstrunk,Romano Schneider,Kaspar Baltzer,Beat P Müller,Johannes Baur,Daniel C Steinemann
BACKGROUNDSuperiority of robotic inguinal hernia repair compared with a laparoscopic minimally invasive approach remains unproven. The aim of this study was to evaluate postoperative pain after laparoscopic totally extraperitoneal repair (TEP) compared with robotic transabdominal preperitoneal repair (rTAPP).METHODSThis was a prospective, patient- and investigator-blinded, two-group, single-centre RCT conducted at a tertiary Swiss healthcare institution including 182 patients undergoing elective primary inguinal hernia repair. Patients were randomized 1 : 1 and stratified according to BMI and unilateral or bilateral hernia to either TEP or rTAPP. Surgery took place between March 2022 and November 2024. The primary endpoint was postoperative pain while coughing 24 h after surgery. Surgical workload (assessed using the National Aeronautics and Space Administration (NASA) Task Load Index (TLX)) was also recorded.RESULTSIn total, 91 patients (93% male, mean(s.d.) age of 56.8(15.2) years, mean(s.d.) BMI of 24.8(3) kg/m2, and 22% with bilateral hernias) were randomized to TEP and 91 patients (95% male, mean(s.d.) age of 55.1(14.5) years, mean(s.d.) BMI of 24.6(2.9) kg/m2, and 21% with bilateral hernias) were randomized to rTAPP. Primary outcome data were available for 90 TEP patients and 88 rTAPP patients. The median postoperative pain while coughing on a numeric rating scale 24 h after surgery was 5 (interquartile range (i.q.r.) 2-7) after TEP and 4 (i.q.r. 2-7) after rTAPP (P = 0.431, Cohen's d = 0.12). The mean(s.d.) operating time for unilateral hernias was 64.2(19.2) min for TEP and 80.3(20.9) min for rTAPP (P < 0.001). Ten (11%) postoperative complications occured after TEP and nine (10%) after rTAPP (P > 0.999). The mean(s.d.) NASA raw TLX score was 34.0(17.2) after TEP and 18.4(10.7) after rTAPP (P < 0.001).CONCLUSIONrTAPP demonstrated no superiority over TEP regarding postoperative pain and complication rates. rTAPP was associated with a reduced surgeon workload at the expense of a longer operating time.REGISTRATION NUMBERNCT05216276 (http://www.clinicaltrials.gov).
{"title":"Robotic versus laparoscopic minimally invasive inguinal hernia repair: randomized clinical trial (the ROGER trial).","authors":"Fiorenzo V Angehrn,Julian Süsstrunk,Romano Schneider,Kaspar Baltzer,Beat P Müller,Johannes Baur,Daniel C Steinemann","doi":"10.1093/bjs/znaf283","DOIUrl":"https://doi.org/10.1093/bjs/znaf283","url":null,"abstract":"BACKGROUNDSuperiority of robotic inguinal hernia repair compared with a laparoscopic minimally invasive approach remains unproven. The aim of this study was to evaluate postoperative pain after laparoscopic totally extraperitoneal repair (TEP) compared with robotic transabdominal preperitoneal repair (rTAPP).METHODSThis was a prospective, patient- and investigator-blinded, two-group, single-centre RCT conducted at a tertiary Swiss healthcare institution including 182 patients undergoing elective primary inguinal hernia repair. Patients were randomized 1 : 1 and stratified according to BMI and unilateral or bilateral hernia to either TEP or rTAPP. Surgery took place between March 2022 and November 2024. The primary endpoint was postoperative pain while coughing 24 h after surgery. Surgical workload (assessed using the National Aeronautics and Space Administration (NASA) Task Load Index (TLX)) was also recorded.RESULTSIn total, 91 patients (93% male, mean(s.d.) age of 56.8(15.2) years, mean(s.d.) BMI of 24.8(3) kg/m2, and 22% with bilateral hernias) were randomized to TEP and 91 patients (95% male, mean(s.d.) age of 55.1(14.5) years, mean(s.d.) BMI of 24.6(2.9) kg/m2, and 21% with bilateral hernias) were randomized to rTAPP. Primary outcome data were available for 90 TEP patients and 88 rTAPP patients. The median postoperative pain while coughing on a numeric rating scale 24 h after surgery was 5 (interquartile range (i.q.r.) 2-7) after TEP and 4 (i.q.r. 2-7) after rTAPP (P = 0.431, Cohen's d = 0.12). The mean(s.d.) operating time for unilateral hernias was 64.2(19.2) min for TEP and 80.3(20.9) min for rTAPP (P < 0.001). Ten (11%) postoperative complications occured after TEP and nine (10%) after rTAPP (P > 0.999). The mean(s.d.) NASA raw TLX score was 34.0(17.2) after TEP and 18.4(10.7) after rTAPP (P < 0.001).CONCLUSIONrTAPP demonstrated no superiority over TEP regarding postoperative pain and complication rates. rTAPP was associated with a reduced surgeon workload at the expense of a longer operating time.REGISTRATION NUMBERNCT05216276 (http://www.clinicaltrials.gov).","PeriodicalId":136,"journal":{"name":"British Journal of Surgery","volume":"28 1","pages":""},"PeriodicalIF":9.6,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145937839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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