Learning curve for robotic-assisted hiatal hernia repair determined by cumulative analysis of adjusted operative times

Abstract

The aim of this study was to assess the learning curve of robotic-assisted hiatal hernia repair. Patients undergoing robotic-assisted hiatal hernia repair from May 2018 to April 2024 were retrospectively included. Clinical characteristics, operative times, and postoperative data were collected. A cumulative summation (CUSUM) analysis of operative times, adjusted for surgical complexity, was conducted. We selected 101 patients who underwent robotic-assisted hiatal hernia repair performed by three surgeons. The mean age was 65.7 ± 14.3 years, with 69 (68.3%) female patients. Adjusted operative times were calculated based on hernia type, age, sex, BMI, and American Society of Anesthesiologists (ASA) score. The CUSUM analysis estimated the learning curve to be between 15 and 21 cases. Only one minor intraoperative complication occurred. Postoperatively, 19 (18.8%) complications were observed, with only 3 (3.0%) classified as grade 3 according to the Clavien-Dindo classification. Complications were evenly distributed between the learning and post-learning phases. After a mean follow-up of 26.5 ± 18.0 months, 13 (12.9%) cases of recurrence were recorded, none of which required surgical revision. Experienced surgeons performing robotic-assisted hiatal hernia repair seem to have a rapid learning curve. A significant reduction in operative time was observed after 15 to 21 cases.