The Safe Introduction of Robotic Surgery Into a Busy Hernia Practice; Patient Outcomes and Learning Curve

Abstract Background The use of robotics in hernia surgery is increasing. Continuous, real-time outcome analysis is vital to inform and protect patients, and enable cost-benefit decisions. Method Prospective data capture on patients undergoing robotic hernia repair during one surgeon’s introduction of robotics into their high-volume practice. Results In the year 2023, 60 hernia repairs were performed robotically: 29 ventral (transabdominal retromuscular umbilical prosthetic n = 12, parastomal Sugarbaker n = 5, transabdominal preperitoneal (TAPP) n = 4, extended totally extraperitoneal n = 4, component separation/transversus abdominis release n = 3, intraperitoneal onlay mesh n = 1); 28 inguinal (TAPP); 3 combined inguinal/ventral. 45 patients (76%) were male, median age 67. Median blood loss was 10 ml, with no blood transfusions. 3 operations (5%) were converted to open. 23 operations (38%) were day-case. There were 2 readmissions; 1 patient returned to theatre and sadly died with pathology unrelated to his hernias. 52 patients (87%) had complication-free recovery. 4 complications were Clavien-Dindo (CD) grade I (urinary retention n = 3, persistent numbness n=1). 2 complications were CDII (pneumonia n = 1; superficial infection n = 1). 2 patients had infections requiring drainage (CDIII). There were no mesh explanations or early recurrences (median follow-up 3 months). Overall median console time was 52 minutes (IQR 38–71). For the first 14 inguinal repairs, median console time was 49 minutes. This decreased to 37 minutes for the following 14 repairs (p 0.001). Conclusion Length of stay, complications, re-admission and recurrence rates are within acceptable parameters, supporting the feasibility of introducing robotic hernia surgery into practice. A learning curve is demonstrated, with rapid significant improvement in operative duration.