Learning Curve in Robotic Primary Ventral Hernia Repair Utilizing Intraperitoneal Onlay Mesh: A Cumulative Sum (CUSUM) analysis
Omar Yusef Kudsi, MD, MBA, FACS1; Fahri Gokcal, MD1; Naseem Bou-Ayash, MD1; Allison S. Crawford, MS2; Sebastian K. Chung, MD2; Karen Chang, MD1; Demetrius Litwin, MD, MBA2
1Good Samaritan Medical Center, Tufts University School of Medicine, Brockton, MA, USA 2Department of Surgery, University of Massachusetts Medical School, Worcester, MA, USA.
Background: Cumulative Sum (CUSUM) learning curves (LC) help analyze individual performance by evaluating the acquisition of new skills and the evolution of those skills with experience. The purpose of this study is to present a CUSUM-LC based on the operative times of robotic intraperitoneal onlay mesh ventral hernia repair (rIPOM-VHR), and identify differences observed throughout its phases.
Methods: rIPOM repairs for elective-primary-midline hernias were evaluated retrospectively. Cumulative sum analysis (CUSUM) and risk adjusted (RA)-CUSUM were used to visualize the LC of rIPOM-VHR, based on operative times and complications. All procedures were performed at a community hospital by one surgeon within a 5-year period.
Results: Out of the ninety rIPOM repairs, 25, 40, and 25 patients were allocated using a CUSUM analysis to early, middle, and late phases, respectively. In terms of skin-to-skin times, the middle phase has a mean duration 23 minutes shorter than the early phase (p
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