Conventional laparoscopic inguinal hernia repair (LIHR) is common and robotic-assisted techniques (RIHR) are increasingly being implemented. Current literature is indecisive on whether RIHR offers clinical and ergonomical benefits. This systematic review compares LIHR and RIHR specifically focusing on surgeon workload and ergonomics. A literature search was performed in four databases to find randomized controlled trials comparing RIHR and LIHR. A risk of bias assessment was conducted using the Cochrane Tool and results were synthesized as pooled estimate, odds ratio or narrative review. Four trials were identified, encompassing 482 patients. The groups showed similar baseline characteristics across studies. A broad range of surgeon experience could be observed between trials. All studies showed a significant difference in operative time, but while three studies found RIHR to take longer, one study reported shorter operative time with RIHR, altogether leading to a non-significant pooled estimate (MD 17.14; 95% CI -3.22 to 37.49). While one study showed significantly better ergonomics with RIHR, the other study reporting on that topic found ergonomics between the two approaches to be comparable. Surgeon task load varied substantially between the trials. The pooled estimate slightly favored RIHR but did not reach statistical significance (MD -4.50; 95% CI -16.78 to 7.78). Postoperative complication rate was not significantly different overall (OR 0.89, 95% CI 0.42 to 1.90), although one study reported significantly less complications after RIHR. RIHR shows comparable patient-centered outcomes to LIHR. At the moment, there is no evidence for significant benefits regarding task load and ergonomics.

A male patient in his seventh decade underwent elective open right inguinal hernia repair. Intraoperatively, we discovered complete spermatic cord duplication-two separate structures, each containing a vas deferens and neurovascular bundle. The hernia repair was successfully completed with careful preservation of both cord structures. To our knowledge, this represents the first reported case of true complete spermatic cord duplication encountered during open inguinal hernia repair. Postoperative ultrasonography confirmed anatomical duplication and vascular patency. This case highlights a critical anatomical variant that demands intraoperative recognition and modified surgical technique to prevent iatrogenic injury and testicular ischaemia, providing a clear management strategy for this rare anomaly.