Summary of ‘Robotic hiatus hernia surgery: learning curve and lessons learned’
This research article, authored by Elisenda Garsot et al., examines the implementation and outcomes of obotic-assisted surgery for hiatal hernia at a tertiary hospital. The study spans a period from June 2019 to March 2024 and covers a total of 58 surgeries conducted on 54 patients. The focus is primarily on perioperative outcomes, symptom resolution, and the learning curve associated with the introduction of robotic techniques in hiatal hernia surgery.
Introduction to Robotic Surgery in Hiatal Hernia
The laparoscopic approach has long been the gold standard for treating hiatal hernias and gastroesophageal reflux disease, achieving satisfactory results in 85–90% of cases. However, the introduction of robotic surgery has provided surgeons with enhanced capabilities, particularly in complex procedures involving fine dissection and suturing. The study highlights that prior experience in laparoscopic surgery is essential for surgeons transitioning to robotic techniques, and emphasizes the importance of a proctored learning environment to mitigate risks associated with the learning curve.
Methodology
The research employed a retrospective, observational design, analysing data collected from a group of patients who underwent robotic-assisted surgery for hiatal hernia. A total of 58 procedures were performed by a single surgeon initially, followed by the involvement of additional colleagues after the first 30 cases. The surgical techniques utilized included both primary and revisional surgeries, with detailed preoperative evaluations conducted to tailor the surgical approach.
Results and Outcomes
The findings revealed that the average surgical time for robotic-assisted surgery for hiatal hernia repair was 124 minutes, with no conversions to laparoscopic or open techniques. The median hospital stay was notably short, averaging just 2 days, and the study reported a high rate of symptom resolution—90% for primary surgeries and 85.7% for revisional surgeries.
The learning curve was analysed using Cumulative Sum (CUSUM) methodology, identifying three distinct phases: training (cases 1 to 14), a plateau phase (cases 15 to 25), and an expertise phase (cases 26 onwards). The results underscore that proficiency in robotic techniques can be achieved with as few as 14 cases, especially with prior laparoscopic experience.
Discussion on Learning Curves and Surgical Safety
The discussion emphasizes the implications of the learning curve on patient outcomes, noting that the surgical team was able to achieve successful results with minimal morbidity and complications. The study aligns with existing literature, indicating that a structured and supervised training pathway can significantly enhance the learning process for robotic procedures.
However, the authors acknowledge limitations in their study, including its retrospective nature and the potential variability introduced by the different types of surgeries performed. Despite these limitations, the study provides valuable insights into the feasibility and effectiveness of robotic-assisted surgery for hiatal hernias, advocating for its use as a training procedure for upper gastrointestinal surgeons.
Conclusions
In conclusion, robotic hiatus hernia surgery demonstrates promise as a safe and effective approach with favourable outcomes. The research indicates that with appropriate training and experience, surgeons can significantly shorten their learning curve, thus enhancing patient safety and improving surgical results. This study contributes to the growing body of evidence supporting robotic surgery’s role in complex gastrointestinal procedures, suggesting that its implementation should be considered seriously in surgical practice.
The authors’ contributions to this research were significant, with collaborative efforts in writing and data analysis. The study was conducted without any specific funding, highlighting the authors’ commitment to advancing surgical techniques in a challenging healthcare environment. Overall, the findings encourage further exploration and adoption of robotic techniques in surgical education and practice.
SOURCE: https://link.springer.com/article/10.1007/s11701-024-02191-3
