Learning Curve of Robotic Rives-Stoppa Ventral Hernia Repair: A Cumulative Sum Analysis.

Journal of Laparoendoscopic & Advanced Surgical Techniques. Part a
Omar Yusef KudsiDemetrius Litwin

Abstract

Background: Robotic Rives-Stoppa ventral hernia repair (rRS-VHR) is a minimally invasive technique that incorporates extraperitoneal mesh placement, using either transabdominal or totally extraperitoneal access. An understanding of its learning curve and technical challenges may guide and encourage its adoption. We aim at evaluating the rRS-VHR learning curve based on operative times while accounting for adverse outcomes. Materials and Methods: We conducted a retrospective analysis of patients undergoing rRS repair for centrally located ventral and incisional hernias. A single surgeon operative time-based cumulative sum (CUSUM) analysis learning curve was created, and a composite outcome was used for risk-adjusted CUSUM (RA-CUSUM). Results: Eighty-one patients undergoing rRS-VHR were included. A learning curve was created by using skin-to-skin times. Accordingly, patients were grouped into three phases. The mean skin-to-skin time was 72.2 minutes, and there was a significant decrease in skin-to-skin times throughout the learning curve (Phase-I: 86.4 minutes versus Phase-III: 63.8 minutes; P = .001), with a gradual decrease after 29 cases. Eleven patients experienced adverse composite outcomes, which were used to create a RA-CUS...Continue Reading

References

Dec 20, 1979·The New England Journal of Medicine·H S LuftA C Enthoven
Feb 1, 2003·Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology·Jim C HuMark S Litwin
Oct 20, 2005·Surgical Endoscopy·S A FraserG M Fried
Jun 6, 2009·Hernia : the Journal of Hernias and Abdominal Wall Surgery·F E MuysomsA Kingsnorth
Sep 8, 2012·Surgical Endoscopy·Alexander Daniel SchroederWolfgang Matthias Johann Reinpold
Jun 4, 2013·Annals of Surgery·Ksenija SlankamenacPierre-Alain Clavien
Sep 1, 2015·American Journal of Surgery·Rebeccah B BaucomBenjamin K Poulose
Jun 12, 2016·Surgical Endoscopy·Jeremy A WarrenAlfredo M Carbonell
Oct 22, 2016·Langenbeck's Archives of Surgery·J SchwarzReinhard Bittner
Apr 11, 2019·Hernia : the Journal of Hernias and Abdominal Wall Surgery·F GokcalO Y Kudsi
Nov 30, 2019·Hernia : the Journal of Hernias and Abdominal Wall Surgery·O Y Kudsi, F Gokcal

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Methods Mentioned

BETA
dissection

Software Mentioned

Excel
TARUP
Statistical Analysis System SAS
CUSUM
SPSS for
RA

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