Introducing robotic surgery in a low-volume, community hospital: outcomes of the first 50 ventral hernia repairs (TARUP)

Background: Robotic transabdominal retromuscular umbilical prosthetic repair (TARUP) is increasingly used for minimally invasive retromuscular ventral hernia repair, but data on implementation and learning curves in low-volume, non-tertiary community hospitals remain limited. We report early outcomes and operative efficiency during program initiation. Methods: Retrospective single-center cohort study in a non-specialist, non-tertiary community hospital. The first 50 consecutive robotic TARUP procedures (2022-2024) were screened; 43 patients were included after predefined exclusions. All hernias were primary midline ventral hernias (EHS width class W1). The primary outcome was operative time (skin-to-skin). Secondary outcomes included non-operative OR time, total OR time, mesh area, early postoperative pain (VAS at 2 h), length of stay (LOS), same-day discharge, and 30-day complications. Learning curves were assessed using chronological tertiles and CUSUM analysis. Results: Retrospective single-center cohort study in a non-specialist, non-tertiary community hospital. The first 50 consecutive robotic TARUP procedures (2022-2024) were screened; 43 patients were included after predefined exclusions. All hernias were primary midline ventral hernias (EHS width class W1). The primary outcome was operative time (skin-to-skin). Secondary outcomes included non-operative OR time, total OR time, mesh area, early postoperative pain (VAS at 2 h), length of stay (LOS), same-day discharge, and 30-day complications (Clavien-Dindo). Learning curves were assessed using chronological tertiles and CUSUM analysis. Conclusion: In a low-volume, non-tertiary community hospital, robotic TARUP showed a clear learning curve with improved operative efficiency over chronological experience and declining minor complications, alongside favorable 30-day recovery outcomes in selected smaller, primary midline ventral hernias. Longer follow-up and broader hernia complexity are needed to assess durability and generalizability.