Description of the Current Da Vinci® Training Pathway for Robotic Abdominal Wall Surgery by the European Hernia Society

Abstract

Background: Robot assisted laparoscopic abdominal wall surgery (RAWS) has seen a rapid adoption in recent years. The safe introduction of the robot platform in the treatment of abdominal wall hernias is important to safeguard the patient from harm during the learning curve. The scope of this paper is to describe the current European training curriculum in RAWS.Methods and Analysis: The pathway to competence in RAWS will depend on the robot platform, experience in other abdominal procedures (novice to expert) and experience in the abdominal wall repair techniques. An overview of the learning curve effect in the initial case series of several early adopters in RAWS was reviewed. In European centres, current training for surgeons wanting to adopt RAWS is managed by the specific technology-based training organized by the company providing the robot. It consists of four phases where phases I and II are preclinical, while phases III and IV focus on the introduction of the robotic platform into surgical practice.Conclusion: On behalf of the Robotic Surgery Task Force of the European Hernia Society (EHS) we believe that the EHS should play an important role in the clinical phases III and IV training. Courses organized in collaboration with the robot provider on relevant surgical anatomy of the abdominal wall and procedural steps in complex abdominal wall reconstruction like transversus abdominis release are essential. Whereas the robot provider should be responsible for the preclinical phases I and II to gain familiarity in the specific robot platform.

The emerging role of robotics in plastic and reconstructive surgery: a systematic review and meta-analysis

“…Vierstraete et al describe the current training pathway of abdominal wall reconstruction and ventral hernia repair and found in their experience of posterior component separation that there was a gradual reduction in operative time until the surgical team reached their ‘comfort zone’ at around 20–25 cases. Depending on the frequency with which this procedure is performed, it may take a long period of time for the surgeon to reach that level of experience [ 189 ].…”

RAWS4all project: validation of a new silicone model for robotic TAPP inguinal hernia repair

“…Recently, abdominal wall surgery has been recognized as a subspecialty by the Unión Européenne des Médecins Spécialistes (UEMS), in collaboration with the European Hernia Society (EHS) [ 15 ] mostly because of a greater awareness of hernia clinical and community implications, complexity of the abdominal wall anatomy, development and description of new procedures and materials for hernia repair. Nowadays, a minimum number of procedures to achieve proficiency in TAPP repair is not well established yet [ 2 , 3 , 10 ] although some groups defend around 50–100 procedures as the minimum number for TAPP learning curve [ 24 ].…”

“…At the moment, the principal rAWS training pathway is controlled by Intuitive Surgical, Inc® and consists of 5 phases (TR100 and TR200-preclinical, TR300, TR400 and TR500—clinical) including online, video-based, hands-on and live surgery sessions with a proctor [ 27 ]. However, this pathway was designed for generic robotic surgery and it is not rAWS-specific so scientific societies such as the EHS should play the most important role in the design and implementation of these pathways [ 15 ]. In 2023, the Robotic4all Project [ 21 ] showed that a 2-h, non-procedure specific program can be useful for the initial phase of the robotic training pathway.…”

“…Robotic surgery, particularly in the United States [ 9 ], is constantly growing and robotic Abdominal Wall Surgery (rAWS) has seen a rise in reported cases in the literature [ 10 ], demonstrating comparable results to other minimally invasive approaches in terms of postoperative complications [ 11 , 12 ] and recurrence rates [ 13 ]. The first robotic hernia repair was described in 2007 [ 14 ] and since then, rAWS increased several folds [ 15 ]. Sheetz et al [ 16 ] reported a remarkable increase in robotic inguinal hernia repair, from 0.7 to 28.8% (41.1-fold change) and robotic ventral hernia repair, from 0.5 to 22.4% (44.8-fold change) in just 6,5 years.…”

Education in Robotic Hernia Surgery—Current Situation

“…The repetition of a simulated tasks (under supervision) over a period of time leads to an improvement in results. • Phase IV: Initial case series: the best cases for beginners are primary inguinal hernia and small ventral or umbilical hernias (intraperitoneal underlay mesh-IPUM) • Phase V: Continued development and advanced training: surgeon-led training with a focus on the technical and anatomical aspects of abdominal wall repair procedures (robotic retrorectus ventral hernia repair (RRVHR) [16][17][18][19][20].…”