Introducing Senhance robotic totally extraperitoneal (TEP) hernioplasty: initial experiences, learning curve, and...

Laparoscopic totally extraperitoneal (TEP) inguinal hernioplasty offers less pain and faster recovery than open repair, but it is technically demanding. The Senhance surgical system integrates eye-tracking, haptic feedback, and reusable instruments; however, robust clinical data in TEP remain limited. Between January 2019 and July 2023, we prospectively enrolled 109 adults who underwent Senhance-assisted TEP (S-TEP) at a single center; 57 retrospective laparoscopic TEP (L-TEP) served as an operative-time benchmark. Patients with prior pelvic-malignancy surgery, ascites, peritoneal dialysis, emergency surgeries, or general anesthesia intolerance were excluded. Patient demographics, hernia type, operative time, 30-day complications, pain scores, length of stay, recurrence, and chronic pain were recorded systematically. We used cumulative-sum (CUSUM) analysis to assess the learning curve, and compare the operative-time with L-TEP after overlap weighing balance. All S-TEP procedures were completed robotically without conversions or intra-operative complications. CUSUM revealed a three-phase learning curve, reaching proficiency after ≈50 cases as mean operative time fell from 145 ± 32 min to 93 ± 18 min (p < 0.001). Thirty-day morbidity was 6.4%, mainly early seroma or hematoma. At a median 50-month follow-up, recurrence and chronic pain rates were 0.9 and 1.8%, respectively. Weighted analysis showed that operative time in the mature S-TEP phase matched L-TEP. S-TEP is feasible and safe for inguinal hernioplasty, achieving favorable mid-term outcomes comparable to laparoscopic standards after a learning curve of roughly 50 cases. Further validation through larger, multicenter studies are warranted.