Why choose Da Vinci robotic surgery

Almost every week a patient asks me if robotic surgery is "better." And the honest answer — the one I actually give in the office — isn't an automatic "yes." It's more interesting than that, and I think you deserve the full version, not the marketing version.

What the technology actually offers

The Da Vinci system delivers high-definition 3D vision with real depth perception, and wristed instruments with 7 degrees of freedom — the EndoWrist — that eliminate the fulcrum effect of the straight instruments used in conventional laparoscopy. Add tremor filtration and motion scaling, and the result is more dexterity and precision in tight spaces, like the retromuscular plane of the abdomen. A hernia-specific review reports complete fascial closure in over 90% of robotic cases, versus about 50% with the laparoscopic technique in the studies it cites.

That's real. But a better instrument doesn't automatically translate into a better outcome for the patient in every operation — and that's exactly where most conversations about robotic surgery go wrong.

Robotic vs. open surgery — here the advantage is clear

When I compare robotic surgery to traditional open surgery, the data is consistent and favorable: recent systematic reviews on complex abdominal wall reconstruction show shorter hospital stays — between 1.5 and nearly 4 fewer days —, fewer wound infections, and lower mortality with robotic surgery. For large, complex reconstructions, that's a real advantage, not a promotional one.

Robotic vs. laparoscopy — here I'd rather be honest

When I compare robotic surgery to laparoscopy — the other minimally invasive technique — the picture changes. Two well-designed randomized clinical trials, RIVAL and ROGER, directly compared robotic and laparoscopic inguinal hernia repair, performed by surgeons experienced in both techniques. Neither found a significant difference between them in postoperative pain, complications, or recovery. Robotic surgery took 16 to 35 minutes longer, on average, and cost more. The most consistent benefit found wasn't for the patient — it was for the surgeon: less physical strain and fatigue during the operation, measured with validated workload scales.

A 2025 review pooling 67 studies on robotic ventral hernia repair reached a similar conclusion: limited advantages compared with laparoscopy, with longer operative time and no consistent gain in complication rates.

Where robotic surgery really makes a difference

That said, there are situations where I choose robotic surgery without hesitation: large, complex abdominal wall reconstructions; obese patients (where studies show lower complication rates and shorter hospital stays with robotic surgery, even at higher cost); and hernias in positions that require fine suturing in very confined spaces, where the instrument's articulation makes a real difference in the quality of the repair. The learning curve for the robotic technique runs about 20 to 35 cases, which underscores the importance of the surgeon's experience with the platform — not just the technology itself.

My view as a surgeon

I don't see robotic surgery as an automatic upgrade — I see it as an excellent tool that I choose case by case. For a straightforward inguinal hernia, the difference for the patient between robotic surgery and well-performed laparoscopy tends to be small. For a complex abdominal wall reconstruction, or for an obese patient with a large hernia, robotic surgery is often my first choice, based on what the evidence shows — not on what's most modern. In the consultation, that's exactly the evaluation I make: which technique is right for your case, not which one sounds the most impressive.