Learning curve of robotic-assisted transabdominal preperitoneal repair (rTAPP) for inguinal hernias

Proietti, Francesco; Regina, Davide La; Pini, Ramon; Giuseppe, Matteo Di; Cianfarani, Agnese; Mongelli, Francesco

doi:10.1007/s00464-020-08165-4

Cited by 31 publications

(26 citation statements)

References 25 publications

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“…Our evaluation of the LC of a simple surgical technique excluded the effects of differences, such as surgical team performance or docking the da Vinci robotic system, other than operative or console time. Reports of completed LC for R‐TAPP by expert surgeons in L‐TAPP varied from 25 to 139 cases, but the majority of studies reported 30–50 cases, similar to our results 13–18 . We also performed 50 cases of RG during the same period.…”

Section: Discussionsupporting

confidence: 83%

“…Reports of completed LC for R‐TAPP by expert surgeons in L‐TAPP varied from 25 to 139 cases, but the majority of studies reported 30–50 cases, similar to our results. 13 , 14 , 15 , 16 , 17 , 18 We also performed 50 cases of RG during the same period. The LC in our report may be skewed, as it does not take into account the proficiency gained from using the robotic system in RG interspersed with R‐TAPP procedures.…”

Section: Discussionmentioning

confidence: 99%

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How to Establish the Bipolar Forceps Dissection Method in Robotic Inguinal Hernia Repair

Saito

Fukami

Komatsu

et al. 2021

Annals of Gastroent Surgery

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The number of robotic inguinal hernia repair (RIHR) surgeries performed by younger surgeons and surgical residents has been growing worldwide. As a result, there has been growing interest in the pace at which surgeons develop their competencies. In Japan, the number of robotic surgeries with the double bipolar technique for gastric cancer is increasing. We devised an RIHR technique for a right‐hand‐dominant surgeon. This article describes the procedure and step‐by‐step instructions for this technique. We also assessed the learning curve of a surgeon experienced in the laparoscopic transabdominal preperitoneal (TAPP) approach and robotic gastrectomy. This was a retrospective review of 31 inguinal hernia patients (40 lesions) between December 2018 and April 2021 operated by a single surgeon. The cumulative summation technique (CUSUM) was used to construct a learning curve for robotic proficiency by analyzing the times for peritoneal flap creation, mesh placement, and peritoneal closure. The postoperative course, namely, the length of hospital stay, 30‐d complications, and 30‐d readmission rates, was evaluated. The CUSUM graph for the total time for each phase indicated an initial decrease at lesion 12 and another decrease at lesion 36, generating three distinct performance phases: learning (n = 12 procedures), competence (n = 24), and mastery (n = 4). Between the early and late periods, no significant differences in patient characteristics or surgical outcomes were found. The learning curve for this technique was divided into three performance phases, and the technique was safely achievable in 36 procedures by a surgeon with previous experience in laparoscopic TAPP.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

How to Establish the Bipolar Forceps Dissection Method in Robotic Inguinal Hernia Repair

Saito

Fukami

Komatsu

et al. 2021

Annals of Gastroent Surgery

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“… 35 , 48 Beyond orthopedics, CUSUM-based operative learning curves have reported to be approximately 30 cases for robot-assisted colorectal surgery, approximately 50 cases in surgical resection of advanced ovarian cancer, and 43 cases for robot-assisted transabdominal preperiotoneal repair of inguinal hernias. 31 , 37 , 43 Notably, the CUSUM learning curve for operative time is shorter than complication rate for the two surgeons in our series while no learning curve for patient reported outcomes was reported.…”

Section: Discussionmentioning

confidence: 62%

Results of single-incision distal biceps tendon repair for early-career upper-extremity surgeons

et al. 2023

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“…The learning curve of r-TAPP is steep and the described reductions in surgery time are proof of the rapid and intuitive adoption of the advantages of robotics [27,28]. In a study of r-TAPP from Italy, it was calculated that after 43 r-TAPPs operated by experienced surgeons, the learning curve reached the plateau (from 70 to 61 min; [29]). The r-TAPP learning curve of the European pioneer of robotic hernia repair Filip Muysoms from Belgium, shows similar results: in one year the operating time (incision-to-skin-closure) was reduced from 80 to 60 min; in Muysoms et al the average console time for unilateral hernias is 43 min (total operating time 94 min), for bilateral hernias 65 min (total operating time 119 min; [27]).…”

Section: Discussionmentioning

confidence: 99%

Robotic hernia surgery I. English version

Ramser

Baur

Keller

et al. 2021

Chirurg

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The treatment of inguinal hernias with open and minimally invasive procedures has reached a high standard in terms of outcome over the past 30 years. However, there is still need for further improvement, mainly in terms of reduction of postoperative seroma, chronic pain, and recurrence. This video article presents the endoscopic anatomy of the groin with regard to robotic transabdominal preperitoneal patch plasty (r‑TAPP) and illustrates the surgical steps of r‑TAPP with respective video sequences. The results of a cohort study of 302 consecutive hernias operated by r‑TAPP are presented and discussed in light of the added value of the robotic technique, including advantages for surgical training. r‑TAPP is the natural evolution of conventional TAPP and has the potential to become a new standard as equipment availability increases and material costs decrease. Future studies will also have to refine the multifaceted added value of r‑TAPP with new parameters.

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Learning curve of robotic-assisted transabdominal preperitoneal repair (rTAPP) for inguinal hernias

Cited by 31 publications

References 25 publications

How to Establish the Bipolar Forceps Dissection Method in Robotic Inguinal Hernia Repair

How to Establish the Bipolar Forceps Dissection Method in Robotic Inguinal Hernia Repair

Results of single-incision distal biceps tendon repair for early-career upper-extremity surgeons

Robotic hernia surgery I. English version

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