Evaluating the learning curve of Dexter-assisted rTAPP: feasibility, safety, and early outcomes at a high-volume hernia center

Introduction: Robotic-assisted surgery has been associated with enhanced precision and the potential to reduce postoperative complications in preperitoneal inguinal hernia repair. The novel Swiss robotic platform Dexter, designed as an open and adaptable system, integrates into conventional laparoscopic setups. It was introduced at our high-volume hernia center, where total extraperitoneal hernia repair (TEP) previously served as the standard of care.

Aim: This study aims to evaluate the clinical outcomes and feasibility of robotic transabdominal preperitoneal hernia repair (rTAPP) using the Dexter platform during the initial learning curve at a Cantonal Hospital in Switzerland.

Methods: From February to December 2024, consecutive patients undergoing Dexter-assisted rTAPP were prospectively enrolled in a database. Postoperative outcomes, including prolonged pain, were assessed during follow-up visits 6–8 weeks after surgery. Importantly, none of the participating surgeons had prior routine experience with robotic surgical platforms before Dexter's implementation.

Results: A total of 66 patients (82% male, median age 61 years, IQR 54–71) underwent rTAPP, with 91% presenting bilateral hernias and 6 cases involving recurrences. The median operative times for bilateral and unilateral hernias were 108 minutes (IQR 93–140) and 90 minutes (IQR 79–109), respectively. Major postoperative complications (Clavien-Dindo grade≥3) occurred in two patients (3%), both requiring relaparoscopy—one for pain out of proportion on postoperative day 1 and one for foreign body retrieval.

Follow-up data were available for 39 patients (70%). Among these, 83% reported no pain, 14% reported mild pain, and 3% reported moderate pain. There were no hernia recurrences observed during the follow-up period.

Conclusions: Dexter-assisted rTAPP can be safely implemented during the learning curve, demonstrating acceptable safety and feasibility. However, the learning curve is associated with prolonged operative times. Further studies with expanded robotic experience and longer follow-up are required to assess potential benefits, particularly in reducing chronic pain.

Publication History

Article published online:
04 September 2025