Robotic hernia repair: the trainee “Drag” factor—a single-surgeon 9-year experience

A. R. Mikhail, LSU Health Sciences Center - New Orleans
L. Daniels, Franciscan Health Physicians
D. Cobb, Franciscan Health Physicians
Y. Kawji, LSU Health Sciences Center - New Orleans
C. Issa, LSU Health Sciences Center - New Orleans
D. M. Danos, LSU Health Sciences Center - New Orleans
K. LeBlanc, LSU Health Sciences Center - New Orleans


Purpose: The use of robotic assisted surgery is increasing but training residents in its use may be associated with increased operative time and cost. The objective of this study is to compare the operative time of robotic incisional/ventral hernia repair (RIVHR) and robotic inguinal hernia repair (RIHR) when performed with and without a resident or fellow trainee. Methods: A review of prospectively collected data was performed on all patients who underwent RIVHR and RIHR by a single surgeon over a 9-year period (2014–2023). Study variables included presence of trainee (resident or fellow), procedure time, console time, and recurrent hernia. Primary outcomes include procedure time and console time. Results: A total of 402 surgeries were included for analysis. Residents assisted in 190 (47%) of the procedures, while fellows assisted in 97 (24%), and 115 (29%) were performed without a trainee. Median (IQR) console times in RIVHR assisted by fellows was 102 (72–145) minutes, compared to 90 (71–129) minutes among surgeries assisted by residents and 65 (52–82) minutes among surgeries performed without a trainee (p < 0.0001), a similar trend was observed for RIHR. The duration of hernia repair assisted by trainees was significantly longer than surgeries performed without a trainee. Conclusion: Operative time for RIVHR and RIHR is significantly lower when performed without a trainee. However, RIHR assisted by residents showed a consistent decrease in operative time over the 9-year period.