Robotic hiatus hernia surgery: learning curve and lessons learned.

Area of Science:

• Minimally Invasive Surgery
• Surgical Technology
• Gastrointestinal Surgery

Background:

• Robotic surgery requires specialized training for patient safety and optimal outcomes.
• Hiatal hernia repair is a suitable procedure for surgeons transitioning to robotic techniques.
• Evaluating the implementation and learning curve of robotic hiatal hernia surgery is crucial.

Purpose of the Study:

• To assess the outcomes of robotic hiatal hernia surgery at a tertiary hospital.
• To analyze the surgical learning curve associated with the robotic approach.
• To evaluate perioperative results and symptom resolution after robotic antireflux surgery.

Main Methods:

• Retrospective review of 54 patients (58 surgeries) from June 2019 to March 2024.
• Inclusion of primary and revision robotic antireflux surgeries.
• Cumulative Sum analysis to assess the surgical learning curve.

Main Results:

• No conversions to laparoscopic or open surgery were required.
• High symptom resolution rates: 90% for primary and 85.7% for revision cases.
• Learning curve identified with three phases: training (1-14), plateau (15-25), and expertise (25+).

Conclusions:

• Robotic hiatal hernia surgery is feasible, demonstrating minimal morbidity and short hospital stays.
• Excellent functional results and symptom resolution were achieved.
• Prior laparoscopic and esophagogastric surgery experience can shorten the robotic learning curve to 14 procedures.