Background

Despite heightened interest in robotic transversus abdominis release (rTAR), concerns over its steep learning curve (LC) and associated challenges may limit its adoption. This study defines the operative time and morbidity-based LC of a single surgeon’s experience with rTAR.

Methods

A retrospective analysis of patients undergoing rTAR over an 8-year period was conducted. Consecutive ventral and incisional hernia repairs were stratified into four sub-categories based on bilaterality and complexity, with complex hernias being defined as those > 10 cm. Cumulative sum analyses (CUSUM) were used to evaluate skin-to-skin time and morbidity LCs.

Results

This study included a total of 156 rTARs with a mean skin-to-skin time of 222.8 min. Mean skin-to-skin times (min) for sub-categories were as follows: unilateral non-complex (137.6), bilateral non-complex (206.8), unilateral complex (241.9), and bilateral complex (298.6). The CUSUM-LC was obtained by summing the differences between each procedure’s operative time and its sub-category mean, revealing a quadratic best-fit line maximum at case 49 and a transition point between early and late phases at case 75. Although skin-to-skin times between early and late phases did not differ significantly (235.3 vs 211.2, respectively; p = 0.12), a significant difference was found in console times. Overall postoperative complications also decreased significantly from early to late phases (41.3% vs 25.9%; p = 0.041). Postoperative complications were predicted by a history of wound infection (c = 0.61).

Conclusions

This study reveals that the rTAR LC was overcome between 49 and 75 cases, after which, console time and postoperative complications decreased significantly.

中文翻译：

---

腹疝修复中机器人腹横肌松解的学习曲线：累积和（CUSUM）分析

背景

尽管对机器人腹横肌释放 (rTAR) 的兴趣日益浓厚，但对其陡峭的学习曲线 (LC) 和相关挑战的担忧可能会限制其采用。本研究定义了单个外科医生使用 rTAR 经验的手术时间和基于发病率的 LC。

方法

对接受 rTAR 的患者进行了 8 年的回顾性分析。根据双侧性和复杂性，连续腹侧和切口疝修补分为四个子类别，复杂疝定义为> 10 cm。累积和分析 (CUSUM) 用于评估皮肤接触时间和发病率 LC。

结果

本研究共纳入 156 例 rTAR，平均皮肤接触时间为 222.8 分钟。子类别的平均皮肤接触时间 (min) 如下：单侧非复杂 (137.6)、双侧非复杂 (206.8)、单侧复杂 (241.9) 和双侧复杂 (298.6)。CUSUM-LC 是通过将每个程序的手术时间与其子类别平均值之间的差异相加获得的，揭示了病例 49 的二次最佳拟合线最大值和病例 75 的早期和晚期阶段之间的过渡点。 - 早期和晚期的皮肤时间没有显着差异（分别为 235.3 和 211.2；p  = 0.12），在控制台时间方面发现了显着差异。从早期到晚期，总体术后并发症也显着减少（41.3% vs 25.9%；p = 0.041)。术后并发症由伤口感染史预测（c  = 0.61）。

结论

本研究表明 rTAR LC 在 49 至 75 例之间被克服，之后，控制台时间和术后并发症显着减少。