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Page 255 Collins et al. Art Int Surg. 2025;5:254-69 https://dx.doi.org/10.20517/ais.2024.92

[1]
of the most common surgical procedures . The hernia repair devices and consumables market has
[2]
increased from $4.7 billion in 2019 to a projection of $6.4 billion by 2027 . This is driven by advanced
prosthetics, increasing adoption of robotic surgery, and a higher global prevalence rate .
[3]
Abdominal wall hernias may be naturally occurring or acquired. Naturally occurring hernias include
inguinal (groin area, most common), femoral (lower groin, more common in women), umbilical (near the
belly button, common in infants and pregnancy), and epigastric (midline upper abdomen). Acquired
hernias include incisional hernias, which develop at previous surgical sites due to weak healing, and
[4]
parastomal hernias , which form around a stoma due to abdominal wall weakness. Other types include
Spigelian hernias (along the lateral abdominal muscles) and diastasis recti, a separation of abdominal
muscles rather than a true hernia.

Hernia surgery often requires specialized skills beyond the scope of a general surgeon , and the challenges
[5]
are attributed to several factors:

Complex anatomy: The groin region is considered anatomically complex , and precise anatomical
[6]
knowledge is critical to avoid injury to nerves, blood vessels, or organs.

Mesh complications: Prosthetic meshes are frequently used in hernia repair; however, they introduce risks
of infection, rejection, or adhesion to underlying organs. Surgeons must choose the appropriate mesh type,
size, and placement method. The mesh must be suitably fixed, and the use of staplers or tackers, if placed
incorrectly, carries greater risks of chronic postoperative pain .
[7-9]

Large or complex defects: Repairing large or recurrent hernias or abdominal wall defects requires advanced
techniques, such as component separation, to provide adequate and durable prosthetic support to prevent
recurrence.

Tissue tension and closure: Achieving a tension-free closure is vital to prevent recurrence , yet this can be
[10]
difficult, especially in larger defects or after multiple surgeries, as tissue may be compromised or retracted.

Obesity and comorbidities: Patients with obesity or other conditions such as diabetes pose additional
challenges due to thicker abdominal walls, a higher risk of infection, and difficulty in achieving a tension-
[11]
free repair.

To address the above challenges, surgeons must carefully balance technical precision, material selection, and
personalized patient care to improve outcomes. Specialized training, such as WebSurg’s Hernia
[12]
Basecamp , might be an important factor in reducing recurrence and complication rates, in addition to
advances in material science in mesh design, biomaterials that support regenerative medicine, and immune
engineering . However, despite these initiatives and research directions, long-term follow-up of hernia
[13]
patients is often disappointing, both in terms of complications and reoperation rates that remain
unacceptably high (8% to 15% [1,14,15] ).

AI technologies have greater potential to improve abdominal wall and hernia surgery [16,17] , including
applications in preoperative planning and risk assessment, intraoperative guidance and safety enhancement,
postoperative monitoring, and surgery training. However, AI adoption in routine clinical practice has been
relatively slow compared to generative AI models, such as ChatGPT, in broader society. As of today, while
research in AI and AWS has advanced, there are not yet certified AI devices specifically designed to assist