Purpose Open repair of incisional hernias largely remains the gold standard in Australia today. Laparoscopic repair, whilst beneficial for groin hernias has remained controversial as a technique due to the technical challenges of fascial closure and the complications that arise from intraperitoneal mesh placement. This study assesses the benefits and outcomes of robotic assisted enhanced-view totally extra-peritoneal (eTEP) mesh placement for incisional hernia repair as compared to open repair. Methodology Participants who underwent open or robotic eTEP incisional hernia repair in 2019-2025 at four institutes in South Australia were identified retrospectively and invited to participate. The primary outcome assessed was patient satisfaction and patient reported outcome measures (PROMS) at 12-months, assessed by the Carolinas Comfort Scale. Secondary outcomes included hernia recurrence, length of stay, complications (including wound infection), pain and symptom improvement 12 months postoperatively. Results The outcomes of patients undergoing robotic approach were compared with open surgery. 12 months post operatively median comfort scores of 0 for robotic (IQR 0-1) and 2 for open (IQR 0-14) p <0.01 were observed. A significant rate of hernia recurrence was also observed in the open group – nine (17.3%) versus 0 in the robotic group. Respiratory complications and surgical site infections were significantly higher in the open group with similar length of stay. Patient satisfaction was significantly superior with a robotic approach with 97.1% of patients reporting improvement of symptoms. Conclusion Robotic eTEP hernia repair offers a superior repair in the setting of both primary and recurrent incisional hernias. Our data supports existing literature in highlighting the advantages of a minimally invasive approach to immediate outcomes, as well as underlining the superior 12-month outcomes associated with fascial closure and extraperitoneal mesh placement.