BACKGROUND: The role of robot-assisted approach in hernia surgery remains controversial due to high procedural costs and the proposed equal outcomes compared with open surgery. In this study, we report the 30-day results of the introduction of robot-assisted approach in a specialized regional ventral hernia repair center. METHODS: This was a retrospective single-center cohort study including patients undergoing either robot-assisted or open ventral hernia repair from 2017 to 2022. Patients undergoing either approach were matched by propensity scores in a 1:2 ratio on the variables age, type of hernia (primary/incisional), and horizontal fascial defect size to reduce bias risk. Multivariable logistic regression on outcomes length of stay, reoperation, and readmission was performed. RESULTS: A total of 109 patients undergoing robot-assisted repair were compared to 229 undergoing open repair. Overall, 61.2% were patients had incisional hernia. Mean hernia defect size was 4.9 × 6.5 cm (horizontal × vertical). The mean length of stay was shorter after robot-assisted repair (0.1 vs. 1.9 days, p <
0.001) as was the incidence of readmission (3.7% vs. 17.0%, p <
0.001). The incidence of reoperation was tangentially significantly lower after robot-assisted repair (0.9% vs. 6.6%, p = 0.045)
however, the estimate was significant after adjusting for confounders (OR 0.11, CI 0.01-0.89, p = 0.038). CONCLUSIONS: Length of stay and readmission rates were significantly decreased after the introduction of a robot-assisted approach for ventral hernia repair.