Surgeons transitioning from laparoscopic to robotic-assisted inguinal hernia repair: a prospective analysis of efficiency.

Background: Available reports of surgeon efficiency when transitioning from laparoscopic to robotic-assisted (RA) inguinal hernia repair (IHR) are retrospective or describe single-center experience. The purpose of this study is to provide a prospective, multi-surgeon, multi-center assessment of surgeon efficiency when transitioning from Lap-IHR to RA-IHR.

Methods: General surgeons with Lap-IHR experience (≥300 Lap-IHRs prior to the study) but with no robotic experience (no RA cases one year prior to the study) consented to participate in this prospective, observational pilot study of their surgical efficiency as they adopted RA-IHR. Efficiency was measured through procedure durations, including skin-to-skin time and time to establish critical view of the myopectineal orifice (MPO). Rates of conversions, and adverse events (AEs) through 30 days post RA-IHR procedure were also reported. Outcomes with 95% confidence intervals (95% CI) describe surgeons' collective and individual unilateral and bilateral early, middle, and late-phase cases, with each surgeon contributing 25 consecutive cases at each phase.

Results: Four surgeons consented to enroll in the study and provided 75 consecutive, prospective RA-IHR cases. Collectively, the surgeons reached relative skin-to-skin time efficiencies for their unilateral repairs in the mid-phase of their prospective cases. For RA-IHR bilateral procedures, skin-to-skin time efficiency was reached in the late-phase cases. Surgeons' skin-to-skin efficiency times varied relative to their retrospective Lap-IHRs. Possible confounders included practice patterns, referrals, proctoring periods, and-for one surgeon-Covid interruptions. One conversion from RA-IHR to open resulted from severe adhesions present after prior prostatectomy. AEs varied broadly from surgeon to surgeon.

Conclusions: The four surgeons improved their skin-to-skin efficiencies.