ArticleSurgical endoscopy2023
Learning curves of robotic extended totally extraperitoneal (eTEP) hernia repair among two surgeons at a high-volume community hospital: a cumulative sum analysis.
Article in Surgical endoscopy, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers, 1 of them a synthesis that pooled it.
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Who cites it
10 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Intraoperative complications of robotic-assisted extended totally extraperitoneal (eTEP) ventral hernia retromuscular repairs with mesh: a systematic literature review and narrative synthesis.Journal of robotic surgery · 2024Pooled it
- Enhanced view/extended totally extraperitoneal plasty (eTEP) Rives-Stoppa repair versus open Rives-Stoppa repair: a single-center retrospective propensity score-matched cohort study.Surgical endoscopy · 2026Article
- Risk-adjusted learning curves for robotic suprapubic preperitoneal totally extraperitoneal (PeTEP) and extended totally extraperitoneal (eTEP) ventral hernia repair: a two-center cohort.Journal of robotic surgery · 2026Article
- Intraoperative adverse events and management strategies in laparoscopic enhanced-view totally extraperitoneal repair (eTEP): a guide to safe introduction.Hernia : the journal of hernias and abdominal wall surgery · 2026Article
- The learning curve of laparoscopic enhanced-view totally extraperitoneal rives stoppa (eTEP-RS) for ventral hernia repair: A cumulative sum (CUSUM) analysis.Hernia : the journal of hernias and abdominal wall surgery · 2025Article
- Early postoperative outcomes in a retrospective propensity score-matched comparison of robotic extended totally extraperitoneal (r-eTEP) and extended totally extraperitoneal (eTEP) repair for ventral hernia.Hernia : the journal of hernias and abdominal wall surgery · 2025Article
- Comparative approach for abdominal wall reconstruction after ventral hernia: open versus minimally invasive surgery.Hernia : the journal of hernias and abdominal wall surgery · 2025Article
- Outcomes During the Learning Curve and Feasibility of Implementing the European Hernia Society Recommendation Guidelines for Robotic Abdominal Wall Surgery Within a UK Centre.Journal of abdominal wall surgery : JAWS · 2025Article
- Adhesions After Laparoscopic IPOM-How Serious Is the Problem?Journal of abdominal wall surgery : JAWS · 2025Review
- Robot-Assisted Extraperitoneal Ventral Hernia Repair-Experience From the First 160 Consecutive Operations With Lateral eTEP and eTAR Techniques.Journal of abdominal wall surgery : JAWS · 2024Article
Corrections and comments
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Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionRobotic extended totally extraperitoneal hernia (eTEP) repair is a novel technique for minimally invasive ventral hernia repair with retromuscular placement of mesh. This study aimed to evaluate the learning curve for robotic eTEP hernia repair using risk-adjusted cumulative sum (RA-CUSUM) analysis for two general surgeons-one with dedicated fellowship training in robotic eTEP technique (surgeon 2) and another without robotic eTEP-specific training (surgeon 1).
methodsWe conducted a retrospective analysis of 98 patients undergoing robotic eTEP hernia repair from July 2020 to February 2022 for two surgeons. RA-CUSUM method was applied to the overall operative time (OT) in minutes, adjusting for transversus abdominis release (TAR).
resultsFigures 3 (surgeon 1) and 4 (surgeon 2) illustrate the three phases in the RA-CUSUM graphs of OT. For surgeon 1, the cases for each phase were determined: phase 1 (1 to 12), phase 2 (13 to 24), and phase 3 (25 to 51). For surgeon 2, the three phases were similarly determined as 1 to 8, 9 to 32, and 33 to 47, respectively. A significant (p = 0.017) difference existed for the OTs between phases 1 (262 ± 69) and 3 (192 ± 63.0) for surgeon 1. OT compared to the risk-adjusted value stabilized after case 12 and decreased after case 24 for surgeon 1; it began to decrease after case 8 for surgeon 2.
conclusionsThe initial learning curve for surgeon 1 reached its plateau after 12 cases, shorter than comparable studies. This was likely due to the surgeon's intentional focus on learning this technique through courses, proctoring, and active mentorship. The flat learning curve seen in surgeon 2's series illustrates the value of experience gained during fellowship training. Our data support that, given the right resources and support, a short learning curve for eTEP is attainable for community surgeons without prior training in the technique.
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