Ester Capuano, Francesco Mongelli, Ramon Pini, Sebastiano Spampatti, Camilla Galbusera, Davide La Regina, Johannes Maria Alberto Toti
The robotic suprapubic approach for preperitoneal totally extraperitoneal (PeTEP) and extended totally extraperitoneal (eTEP) ventral hernia repair is an advanced minimally invasive technique that enables extraperitoneal mesh placement through a caudal access route. However, evidence regarding its learning curve remains limited. This study evaluated its operative-time learning curve. Consecutive adults undergoing robotic suprapubic PeTEP/eTEP ventral hernia repair between January 2020 and November 2025 at two tertiary centers were identified from a prospective database. Operative time was case-mix adjusted by multivariable linear regression; residuals were analyzed using surgeon-specific RA-CUSUM and segmented regression. Overall, 219 patients were analyzed: PeTEP 42%, eTEP 58%; median age 55.1 years (IQR 45.3-63.3), BMI 27.8 kg/m² (IQR 24.4-31.5), W1 defects 77.6%, and median diameter 3.0 cm (IQR 2.0-4.0). RA-CUSUM showed a consistent three-phase pattern. Segmented regression identified transition points at 7/25, 11/21, and 11/23 cases for Surgeons 1-3, corresponding to initial transition after 7-11 cases and stabilization after 21-25. Component-specific docking, console, and undocking/closure analyses showed initial transitions after 5-15 cases and subsequent stabilization after 13-39 cases. Mean operative time was 129 ± 55 min in the pre-stabilization phase versus 132 ± 69 in the post-stabilization phase (p = 0.765). Complications occurred in 24 patients (11.0%), including 3 severe complications (1.4%); no early recurrence was detected during the approximately 4-week postoperative follow-up. Robotic suprapubic ventral hernia repair PeTEP and eTEP demonstrated a short learning curve in experienced robotic abdominal wall surgeons, with initial transition after 7-11 cases and stabilization of risk-adjusted operative performance after 21-25 cases.