Differences in the learning curve of robotic transabdominal preperitoneal inguinal hernia repair according to surgeon’s robotic experience

Abstract

Purpose In this study, we aim to analyze the learning curve of each step of robotic transabdominal pre-peritoneal inguinal hernia repair (rTAPP) in two surgeons with varying degrees of expertise with the robotic platform but no experience with laparoscopic hernia repair. Methods Data on 124 rTAPP cases performed by two surgeons were retrospectively reviewed. Cumulative sum (CUSUM) analysis was applied to visualize the learning curve of rTAPP on operation time of each step of the procedure [the peritoneal flap creation (T1), the completion of the critical view of the myopectineal orifice (T2), the mesh application (T3) and the peritoneal flap closure (T4)]. Each intraoperative and postoperative outcome was compared according to surgeon’s experience with the robotic platform and learning phase. The robotic surgeon mentored the surgeon-in-training and was present during all surgeries in his learning period. Results The surgeon in training with the robotic platform showed a learning phase till the 20th procedure followed by a gradual improvement in performances. The expert surgeon showed a learning phase till the 35th procedure after which a constant decrease of operative time was recorded till the last procedure included. The operative times of each step of the procedures of both surgeons were significantly improved after the learning phase. In the late phase, the surgeon in training could achieve operative times in T2 and T3, which are similar to those of an experienced robotic surgeon with no experience with TAPP before the completion of the learning phase. Conclusions In conclusion, the learning phase of rTAPP surgery may vary between 20 and 35 cases, depending on the surgeon’s experience in robotic surgery.

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].…”