Proposal for the Hernia ASCEND Hugo™ RAS training pathway: acquisition of skills by comprehensive exercise-based nimbleness and dexterity training

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.