Introducing Senhance robotic totally extraperitoneal (TEP) hernioplasty: initial experiences, learning curve, and mid-term outcomes from a single center.

Abstract

Laparoscopic totally extraperitoneal (TEP) inguinal hernioplasty offers less pain and faster recovery than open repair, but it is technically demanding. The Senhance surgical system integrates eye-tracking, haptic feedback, and reusable instruments; however, robust clinical data in TEP remain limited. Between January 2019 and July 2023, we prospectively enrolled 109 adults who underwent Senhance-assisted TEP (S-TEP) at a single center; 57 retrospective laparoscopic TEP (L-TEP) served as an operative-time benchmark. Patients with prior pelvic-malignancy surgery, ascites, peritoneal dialysis, emergency surgeries, or general anesthesia intolerance were excluded. Patient demographics, hernia type, operative time, 30-day complications, pain scores, length of stay, recurrence, and chronic pain were recorded systematically. We used cumulative-sum (CUSUM) analysis to assess the learning curve, and compare the operative-time with L-TEP after overlap weighing balance. All S-TEP procedures were completed robotically without conversions or intra-operative complications. CUSUM revealed a three-phase learning curve, reaching proficiency after ≈50 cases as mean operative time fell from 145 ± 32 min to 93 ± 18 min (p < 0.001). Thirty-day morbidity was 6.4%, mainly early seroma or hematoma. At a median 50-month follow-up, recurrence and chronic pain rates were 0.9 and 1.8%, respectively. Weighted analysis showed that operative time in the mature S-TEP phase matched L-TEP. S-TEP is feasible and safe for inguinal hernioplasty, achieving favorable mid-term outcomes comparable to laparoscopic standards after a learning curve of roughly 50 cases. Further validation through larger, multicenter studies are warranted.