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Review
. 2022 Nov 30:1:10914.
doi: 10.3389/jaws.2022.10914. eCollection 2022.

Description of the Current Da Vinci® Training Pathway for Robotic Abdominal Wall Surgery by the European Hernia Society

Maaike Vierstraete  1 , Maarten Simons  2 , Knut Borch  3 , Andrew de Beaux  4 , Barbora East  5   6 , Wolfgang Reinpold  7 , Cesare Stabilini  8 , Filip Muysoms  1
Affiliations
Review

Description of the Current Da Vinci® Training Pathway for Robotic Abdominal Wall Surgery by the European Hernia Society

Maaike Vierstraete et al. J Abdom Wall Surg. .

Abstract

Background: Robot assisted laparoscopic abdominal wall surgery (RAWS) has seen a rapid adoption in recent years. The safe introduction of the robot platform in the treatment of abdominal wall hernias is important to safeguard the patient from harm during the learning curve. The scope of this paper is to describe the current European training curriculum in RAWS. Methods and Analysis: The pathway to competence in RAWS will depend on the robot platform, experience in other abdominal procedures (novice to expert) and experience in the abdominal wall repair techniques. An overview of the learning curve effect in the initial case series of several early adopters in RAWS was reviewed. In European centres, current training for surgeons wanting to adopt RAWS is managed by the specific technology-based training organized by the company providing the robot. It consists of four phases where phases I and II are preclinical, while phases III and IV focus on the introduction of the robotic platform into surgical practice. Conclusion: On behalf of the Robotic Surgery Task Force of the European Hernia Society (EHS) we believe that the EHS should play an important role in the clinical phases III and IV training. Courses organized in collaboration with the robot provider on relevant surgical anatomy of the abdominal wall and procedural steps in complex abdominal wall reconstruction like transversus abdominis release are essential. Whereas the robot provider should be responsible for the preclinical phases I and II to gain familiarity in the specific robot platform.

Keywords: education; hernia; inguinal hernia; robotic abdominal wall surgery; robotic surgery; robotic training; ventral hernia.

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Conflict of interest statement

MV reports future participation in the Advisory Board of Medtronic. MS is a proctor for Intuitive Surgical. KB and BE report having received financial support for attending Intuitive courses. AdB received consulting fees from Medtronic, CMR surgical and BD Bard as well as speaker’s honoraria from Medtronic and BBraun. WR declares having received payment honoraria for lectures from Ricard Wolf Company. FM reports having received research grants from Medtronic, Intuitive Surgical and FEG Textiltechnik besides speakers’ honoraria from Medtronic, BD Bard, Intuitive Surgical and WL GORE, consultancy honoraria from Medtronic, CMR surgical and expert testimony from Sofradim. FM is proctor for Intuitive Surgical and participates in the Advisory Board of Medtronic. The remaining author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
The 4 phases of the Intuitive training pathway: phases I and II are preclinical, while phases III and IV are the introduction of robot assisted surgery in clinical practice.
FIGURE 2
FIGURE 2
Proposal of a gradual increase in case complexity during the introduction of a RAWS training program. IPOM, Intraperitoneal Onlay Mesh; rTAPP, Robotic assisted Transabdominal preperitoneal prosthetic inguinal hernia repair; rTARUP, Robotic Transabdominal Retrorectus Umbilical Prosthetic hernia repair; eTEP, Enhanced Totally Extraperitoneal hernia repair; rTAR, Robotic assisted Transversus Abdominis Release.
FIGURE 3
FIGURE 3
First 100 cases during the successful implementation of a RAWS program at the centre of one of the authors (MS). rTAPP, Robotic assisted Transabdominal preperitoneal prosthetic inguinal hernia repair; rTARUP, Robotic Transabdominal Retrorectus Umbilical Prosthetic hernia repair; IPOM, Intraperitoneal Onlay Mesh; vTAPP, Transabdominal preperitoneal prosthetic ventral hernia repair; rTAR, Robotic assisted Transversus Abdominis Release; PSH, Parastomal Hernia repair.
See this image and copyright information in PMC

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