Brucchi Francesco, Vierstraete Maaike, Vanderstraeten Eva, Mottrie Alexander, Rashidian Niki, Muysoms Filip
University of Milan, Via Festa del Perdono, 7, 20122, Milan, Italy.
ORSI Academy asl, Melle, Belgium.
J Robot Surg. 2025 Aug 26;19(1):516. doi: 10.1007/s11701-025-02704-8.
Robotic-assisted surgery (RAS) is increasingly applied in abdominal wall repair, yet structured, system-specific training remains inconsistent for emerging platforms like Hugo™ RAS. Existing literature highlights the need for dedicated curricula addressing system ergonomics, docking workflows, and procedural nuances to ensure safe adoption. The Acquisition of Skills by Comprehensive Exercise-based Nimbleness and Dexterity (ASCEND) Hugo™ RAS training pathway was developed collaboratively by ArFiCo Surgical, ORSI Academy, and Medtronic to provide a structured, modular training program for robotic hernia surgery. Building upon established da Vinci training principles, ASCEND integrates simulation, live tissue models, and mentored clinical exposure in a phased approach, ensuring progressive skill development. The pathway consists of preclinical stages, including technology training, simulator-based exercises, and high-fidelity porcine model practice for procedural steps such as robot-assisted inguinal and ventral hernia repairs. A stepwise clinical integration follows, beginning with low-complexity cases, supported by proctoring and ongoing skill assessment. Advanced modules for complex hernia techniques, including robotic transversus abdominis release (roboTAR), and dedicated "Train the Trainer" sessions, ensure scalability and standardized expertise development. The ASCEND pathway offers a comprehensive, reproducible framework for the safe, effective, and scalable adoption of Hugo™ RAS in hernia surgery. By combining Proficiency-Based Progression (PBP), simulation, and structured mentorship, ASCEND fosters surgical excellence while addressing the increasing global demand for high-quality robotic training. Further validation through multicenter studies is recommended to assess its long-term clinical impact.
机器人辅助手术（RAS）在腹壁修复中的应用越来越广泛，但对于像Hugo™ RAS这样的新兴平台，针对系统的结构化培训仍不一致。现有文献强调需要有专门的课程来解决系统人体工程学、对接流程和手术细节问题，以确保安全应用。基于综合练习的敏捷性和灵活性技能获取（ASCEND）Hugo™ RAS培训路径是由ArFiCo Surgical、ORSI Academy和美敦力公司合作开发的，旨在为机器人疝气手术提供一个结构化的模块化培训计划。ASCEND以既定的达芬奇培训原则为基础，分阶段整合模拟、活体组织模型和带教临床实践，确保技能逐步发展。该路径包括临床前阶段，如技术培训、基于模拟器的练习以及针对机器人辅助腹股沟疝和腹疝修复等手术步骤的高保真猪模型实践。接下来是逐步的临床整合，从低复杂性病例开始，由监考和持续的技能评估提供支持。针对复杂疝气技术的高级模块，包括机器人腹横肌松解术（roboTAR），以及专门的“培训培训师”课程，确保了可扩展性和标准化专业技能的发展。ASCEND路径为在疝气手术中安全、有效且可扩展地采用Hugo™ RAS提供了一个全面、可重复的框架。通过结合基于熟练度的进阶（PBP）、模拟和结构化带教，ASCEND在培养卓越手术技能的同时，满足了全球对高质量机器人培训日益增长的需求。建议通过多中心研究进行进一步验证，以评估其长期临床影响。
