Learning Curves and Proficiency Milestones in Robotic Ventral Hernia Repair: A Systematic Review by Surgical Technique.
Gabriela Lyons, Vitor Dos Santos Neves, Maria Clara Morais et al.
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In 30 seconds
This systematic review compared learning curves for different robotic ventral hernia repair techniques using seven retrospective cohort studies, including six single-surgeon series and one population-based analysis. Operative-time proficiency thresholds varied by technique, from 26 cases for robotic intraperitoneal underlay mesh repair to 49 for robotic transversus abdominis release. Complication-adjusted performance generally stabilized later, after 51–64 cases. Prior experience shortened the operative-time learning curve for enhanced-view totally extraperitoneal repair to 8 cases. The authors describe a two-phase, technique-dependent pattern in which efficiency precedes optimal patient outcomes.
Key findings
- Operative-time proficiency thresholds ranged from 26 cases for rIPUM to 49 cases for rTAR.
- Complication-adjusted performance stabilized after 51–64 cases, later than operative-time proficiency.
- Prior experience reduced the r-eTEP operative-time proficiency threshold to 8 cases.
- Population-level analysis suggested 16–19 robotic cases were needed for recurrence-related reoperation rates comparable to open or laparoscopic repair.
Why it matters
The findings distinguish technical efficiency from broader performance, including complication-adjusted outcomes. Training or credentialing based only on operative time may therefore overlook the additional experience associated with more stable outcomes. The variation across techniques and the influence of prior experience also indicate that a single case threshold may not represent proficiency across robotic ventral hernia procedures.
What to keep in mind
The review included only seven retrospective cohorts, with heterogeneous learning-curve methods; six studies were single-surgeon series.