Evaluation of single-port robotic initial treatment of hernias (ESPRITH study): an initial case series following the IDEAL framework

Background: The Da Vinci Single Port has received the CE marking for General Surgery in Europe in 2024. However, its role in hernia repair is largely unexplored. In this study, we present an IDEAL Stage 1 case series evaluating the Da Vinci SP system for hernia repair. Methods: We report the first European case series of SP robotic hernia repair (Da Vinci SP system, Intuitive Surgical). Consecutive patients undergoing inguinal hernia repair (IHR) with concomitant umbilical hernia, or midline ventral hernia repair (EHS M1–M4), were included between October 2024 and July 2025. Inguinal repairs (TAPP/TEP) were performed via the umbilical defect, while ventral repairs employed a suprapubic extraperitoneal access. The primary outcome was intraoperative and postoperative complications; secondary outcomes included operative time, hospital stay, and 1-month morbidity. Results: Twenty-two patients were treated (14 ventral, 8 inguinal with concomitant umbilical hernia). Median operative time was 87 min for IHR and 150 min for ventral repairs. No intraoperative complications, conversions, or additional ports were required. Median length of stay was 19.5 h; six patients (27%) required an unplanned overnight stay for pain management. Two minor complications (seroma, scrotal edema) occurred at 1-month follow-up; no recurrences or readmissions were observed. Conclusions: This IDEAL Stage 1 case series demonstrates the technical feasibility of single-port (SP) robotic hernia repair in selected patients with inguinal and ventral hernias, with no intraoperative or early postoperative complications observed. These preliminary findings support further prospective IDEAL Stage 2–3 studies with larger cohorts, standardized techniques, and long-term follow-up to validate safety and comparative outcomes.