Aim To study the usefulness of learning in simulation and animal model to incorporate laparoendoscopic techniques in ventral hernia in an abdominal wall unit. Material and Methods The training consists of 3 phases and four surgeons participate in it. In a first phase, videos of laparoendoscopic ventral hernia surgeries are displayed. In the second phase, 3 sessions are carried out in a simulation box to practice the zenith suture with a 5 cm diameter defect. For the third phase, each surgeon has four sessions of surgery with swine models; In the first three, a retromuscular dissection procedure was performed, creating and suturing a midline defect of 15×4 cm (long and transverse diameter), placement of mesh in a retromuscular position, and closure of the posterior sheath (laparoscopic RIVES). In the 4th animal model, an extraperitoneal procedure was performed (eTEP) without closure of the posterior rectus sheath. The total time of the intervention and the time used in the zenith suture are analyzed. Results With the first experimental animal, the average time used in suturing was 47.5 minutes, and in the fourth animal it dropped to 35 minutes. The time used to perform the laparoscopic RIVES in the first animal model was 102 minutes and was reduced to 72 minutes in the third. Conclusions Simulation and training models of minimally invasive ventral hernia surgery are useful and necessary in the training of surgeons and improve procedure times and skills.
Aim Laparoendoscopic techniques for inguinal repair (TEP) offers advantages such as less postoperatory pain, less local complication rates and early comeback to work activities. We describe the TEP learning curve in our unit and we present a preliminary analysis of our results. Material and Methods We present the retrospective analysis of patients who underwent TEP inguinal hernioplasty between 2018 and 2021 in a Wall Surgery Unit of Navarra Hospital. We perform a descriptive analysis of the collected data. Results 182 patients were analysed, including 91.6% male with an average age of 57.1 years. 11patients required conversion from TEP to another technique (mainly TAPP and open preperitoneal surgery) due to surgical or anesthetic problems, with a conversion rate of 6%. 4 patients (2%) presented early recurrence and 6 patients (3%) late recurrence. 16 patients (8.8%) had moderate pain (VAS < 5) while 7 patients (3.8%) had severe pain (VAS ≥5). All the patients who presented postoperative pain were reviewed and none presented postoperative neuralgia. No patient showed surgical site infection neither epididymitis. 4 patients (2%) presented seroma and 23 (12.6%) hematoma. Conclusions Laparoendoscopic techniques, especially TEP, has more demanding learning curve than open repairs. Support and tutoring are imperative in the first cases. An adequate selection of cases at the beginning is important. Mastering open preperitoneal hernioplasty surgery leads to better and faster results in TEP approach.
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