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Robotic Ventral Hernia Repair: Lessons Learned from a 7-year Experience. OBJECTIVE: To describe the outcomes of robotic ventral hernia repair (rVHR) with varying prosthetic reinforcement techniques. SUMMARY BACKGROUND DATA: As a recent addition to minimally invasive hernia repair, more data is needed to establish the long-term benefits of rVHR and to identify potential predictors of adverse outcomes. METHODS: Patients who underwent rVHR over a 7-year period were evaluated. Robotic intraperitoneal onlay mesh (rIPOM), transabdominal preperitoneal (rTAPP), Rives-Stoppa (rRS), and transversus abdominis release (rTAR) techniques were compared. The main outcomes were 90-day freedom from complication (FFC) and 5-year freedom from recurrence (FFR), depicted through Kaplan-Meier curves stratified by repair type and date. RESULTS: A total of 644 rVHRs were analyzed; 197 rIPOM, 156 rTAPP, 153 rRS, and 138 rTAR. There was a gradual transition from intraperitoneal to extraperitoneal mesh placement across the study period. While rTAPP had the highest 90-day FFC (89.5%) it also had the lowest 5-year FFR (93.3%). Conversely, while rTAR demonstrated the lowest FFC (71%), it had the highest FFR (100%). Coronary artery disease, lysis of adhesions, incisional hernia, and skin-to-skin time (10 min. increment) were significant predictors of 90-day complications. Incisional hernia was the sole predictor of 5-year recurrence. CONCLUSIONS: This study provides an in-depth perspective of the largest series of rVHR. Based on this experience, rTAPP is no longer recommended due to its limited applicability and high recurrence rate. Both rIPOM and rRS offer encouraging short- and long-term outcomes, while rTAR is associated with the highest perioperative morbidity. Longer follow-up is needed to assess rTAR durability, despite a promising recurrence profile.