Reply to "Critical appraisal of "Proposal for the Hernia ASCEND Hugo™ RAS training pathway: acquisition of skills by comprehensive exercise‑based nimbleness and dexterity training"".

Abstract

We appreciate the constructive comments by Haider et al. regarding our proposal for the Hernia ASCEND Hugo™ RAS training pathway. Their observations underscore key priorities for the ongoing refinement and validation of structured robotic hernia training. In our reply, we emphasize that the ASCEND framework is grounded in the Proficiency-Based Progression (PBP) model, which has demonstrated measurable improvements in surgical performance and safety across multiple specialties. We clarify that while our initial report did not include outcome data, multicenter validation studies linking ASCEND milestones to clinical endpoints are in progress. Moreover, we address concerns about generalizability and cost, reaffirming that ASCEND was independently designed by surgical educators and conceived as a modular and scalable program adaptable to diverse healthcare settings. We share the view that long-term validation should be guided by independent scientific societies to ensure neutrality and global comparability. Through these initiatives, ASCEND aims to contribute to the standardized, outcome-driven, and accessible adoption of robotic hernia surgery worldwide.