Outcomes During the Learning Curve and Feasibility of Implementing the European Hernia Society Recommendation Guidelines for Robotic Abdominal Wall Surgery Within a UK Centre
Bibliographic record
Abstract
Background: Robotic-assisted surgery (RAS) for abdominal wall hernia repair is an established, minimally invasive technique that is in the early phase of adoption within the UK. We aimed to demonstrate the impact on patient outcomes and safety of hernia repair by adhering to the robotic abdominal wall surgery pathway developed by the European Hernia Society. Materials and Methods: Two experienced laparoscopic surgeons in the UK underwent four phases that involved preclinical and clinical phases. The surgeons performed RAS hernia surgery with a stepwise increase in complexity, from robotic transabdominal preperitoneal (rTAPP) inguinal hernia repair, robotic transabdominal retrorectus umbilical prosthesis (rTARUP)/extended totally extraperitoneal (eTEP) to robotic transversus abdominis release (rTAR). Results: In total, 144 patients underwent RAS for hernia repair. Of these, 97 underwent rTAPP inguinal hernia repair (23 bilateral cases). The median operative time was 56 min for unilateral and 101 min for bilateral repair. Four (3.3%) rTAPP patients experienced complications, with two recurrences at the 6-month follow-up. Forty-two patients underwent rTARUP/eTEP repair, with a median operative time of 167 min. Two (4.8%) of these patients experienced postoperative complications. No recurrences were observed at 6 months. Thirteen patients with incisional hernias underwent rTAR, with a median operative time of 426 min. No recurrences were observed in rTAR patients, followed for up to 12 months. Discussion: Implementation of the EHS training pathway for robotic abdominal wall surgery resulted in a low complication rate and satisfactory clinical outcomes and represents a robust mechanism for surgeons to safely adopt complex robotic abdominal wall surgery.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.014 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".