Learning Curves for Robotic-Assisted Ventral Hernia Repair

Area of Science:

• Surgical innovation and patient outcomes
• Minimally invasive surgery techniques
• Hernia repair best practices

Background:

• Robotic-assisted ventral hernia repair (RVHR) use has increased, but surgeon learning curves are unclear.
• Established laparoscopic and open hernia repair techniques have well-defined outcomes.
• Characterizing the experience needed for RVHR is crucial for optimizing patient care.

Purpose of the Study:

• To estimate the learning curves for robotic-assisted ventral hernia repair (RVHR).
• To determine the number of cases required for surgeons to achieve outcomes comparable to laparoscopic and open repairs.
• To analyze the association between surgeon experience and reoperation rates for hernia recurrence.

Main Methods:

• Retrospective cohort study of Medicare fee-for-service patients (2010-2020).
• Included 160,379 ventral hernia repairs (robotic, laparoscopic, open) performed by 23,580 surgeons.
• Multivariate logistic regression analyzed reoperation rates for hernia recurrence, adjusting for covariates.

Main Results:

• Reoperation rates for hernia recurrence decreased with increased robotic-assisted case volume.
• Surgeons needed at least 16-19 robotic-assisted repairs to achieve outcomes similar to laparoscopic/open repairs.
• Only 5.7% of surgeons performing RVHR reached the experience volume needed to overcome the learning curve.

Conclusions:

• Increasing surgeon experience in robotic-assisted ventral hernia repair is linked to better long-term reoperation rates.
• The majority of surgeons performing RVHR have not yet reached the experience threshold for optimal outcomes.
• Further research and training initiatives may be needed to improve RVHR proficiency and patient outcomes.