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Learning curves of robotic extended totally extraperitoneal (eTEP) hernia repair among two surgeons at a high-volume community hospital: a cumulative sum analysis

  • 2023 SAGES Oral
  • Published:
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Abstract

Introduction

Robotic extended totally extraperitoneal hernia (eTEP) repair is a novel technique for minimally invasive ventral hernia repair with retromuscular placement of mesh. This study aimed to evaluate the learning curve for robotic eTEP hernia repair using risk-adjusted cumulative sum (RA-CUSUM) analysis for two general surgeons—one with dedicated fellowship training in robotic eTEP technique (surgeon 2) and another without robotic eTEP-specific training (surgeon 1).

Methods

We conducted a retrospective analysis of 98 patients undergoing robotic eTEP hernia repair from July 2020 to February 2022 for two surgeons. RA-CUSUM method was applied to the overall operative time (OT) in minutes, adjusting for transversus abdominis release (TAR).

Results

Figures 3 (surgeon 1) and 4 (surgeon 2) illustrate the three phases in the RA-CUSUM graphs of OT. For surgeon 1, the cases for each phase were determined: phase 1 (1 to 12), phase 2 (13 to 24), and phase 3 (25 to 51). For surgeon 2, the three phases were similarly determined as 1 to 8, 9 to 32, and 33 to 47, respectively. A significant (p = 0.017) difference existed for the OTs between phases 1 (262 ± 69) and 3 (192 ± 63.0) for surgeon 1. OT compared to the risk-adjusted value stabilized after case 12 and decreased after case 24 for surgeon 1; it began to decrease after case 8 for surgeon 2.

Conclusions

The initial learning curve for surgeon 1 reached its plateau after 12 cases, shorter than comparable studies. This was likely due to the surgeon’s intentional focus on learning this technique through courses, proctoring, and active mentorship. The flat learning curve seen in surgeon 2’s series illustrates the value of experience gained during fellowship training. Our data support that, given the right resources and support, a short learning curve for eTEP is attainable for community surgeons without prior training in the technique.

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Acknowledgements

The authors would like to thank Emily Mazure for her tremendous assistance in literature review for this manuscript.

Disclaimer

This research was supported (in whole or in part) by HCA Healthcare and/or an HCA Healthcare affiliated entity. The views expressed in this publication represent those of the author(s) and do not necessarily represent the official views of HCA Healthcare or any of its affiliated entities.

Funding

No funding has been received for this study.

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Authors and Affiliations

  1. General Surgery Residency, Mountain Area Health Education Center (MAHEC), Asheville, NC, USA

    Katie Korneffel MD

  2. Department of Research, MAHEC, Asheville, USA

    Wendy Nuzzo MS & C. Micha Belden PhD

  3. Department of Surgery, Mission Hospital, HCA Healthcare, Asheville, USA

    Lindsee McPhail MD & Sean O’Connor MD

Authors
  1. Katie Korneffel MD
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  2. Wendy Nuzzo MS
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  3. C. Micha Belden PhD
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  4. Lindsee McPhail MD
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  5. Sean O’Connor MD
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Corresponding author

Correspondence to Katie Korneffel MD.

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Disclosures

Dr. McPhail is a proctor for Intuitive Surgical and Dr. O’Connor is a consultant for Intuitive Surgical and W.L. Gore. These involvements by Dr. McPhail and Dr. O’Connor are outside this submitted work. Drs. Korneffel and Belden, as well as Ms. Nuzzo, have no conflicts of interest or financial ties to disclose.

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Korneffel, K., Nuzzo, W., Belden, C.M. et al. Learning curves of robotic extended totally extraperitoneal (eTEP) hernia repair among two surgeons at a high-volume community hospital: a cumulative sum analysis. Surg Endosc 37, 9351–9357 (2023). https://doi.org/10.1007/s00464-023-10349-7

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  • DOI: https://doi.org/10.1007/s00464-023-10349-7

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