Learning curve in open inguinal hernia repair: a quality improvement multicentre study about Lichtenstein technique

Merola, Giovanni; Cavallaro, Giuseppe; Iorio, Olga; Frascio, Marco; Pontecorvi, Emanuele; Corcione, Francesco; Andreuccetti, Jacopo; Pignata, Giusto; Stabilini, Cesare; Bracale, Umberto

doi:10.1007/s10029-019-02064-x

Cited by 53 publications

(50 citation statements)

References 20 publications

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“…principles of hernia repair and robotic equipment, LC analysis is essential to plan routine and educational sources in clinical practice.Merola et al calculated that nearly 40 operations were needed for a surgeon to become proficient in open hernia repair 11. Same authors reported a number of 65 operations to reach proficiency in the laparoscopic approach 11. Bökeler and colleagues compared trainees with expert surgeons regarding laparoscopic TAPP operations 12.…”

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confidence: 99%

Learning curve analysis of robotic transabdominal preperitoneal inguinal hernia repair

Aghayeva

Aytaç

Dinç

et al. 2020

Robotics Computer Surgery

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Background: The purpose of this study was to assess the learning curve (LC) for inguinal hernia repair with robotic transabdominal preperitoneal (R-TAPP) approach. Methods: Between April 2016 and October 2019, patients who underwent R-TAPP were retrieved. Patient demographics, operative variables and postoperative outcomes were assessed. The moving average method and cumulative sum of operation times (OT) were used to evaluate the LC. The surgeon (BB) in this study had completed his laparoscopic (Lap) TAPP experience. Results: There were 50 (two females) consecutive patients (mean age was 51.7 � 16.9 years). The first phase (learning phase) included initial 35 operations. The second phase included the next 15 operations. It was observed that, with increasing experience, a statistically significant shortening in the average OT by about 25 min was achieved (p ¼ 0.041). Conclusion: The LC phase for R-TAPP, for surgeon with previous experience in Lap TAPP, seems to be very quick without compromising the operative morbidity.

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mentioning

confidence: 99%

Learning curve analysis of robotic transabdominal preperitoneal inguinal hernia repair

Aghayeva

Aytaç

Dinç

et al. 2020

Robotics Computer Surgery

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“…Our participating surgical residents estimated 30-40 procedures (range 20-50) were required to achieve proficiency in open IHR. In previous studies, around 40 open IHR [1], or even 64 repairs were needed for proficiency [29]. In our survey, the estimated number of endoscopic IHR needed to become proficient were 50-75 surgical procedures (range 25-100).…”

Section: Discussionmentioning

confidence: 73%

“…Inguinal hernia repair (IHR) is one of the first surgical procedures that surgical residents learn during their training [ 1 ], as it is a relatively simple surgical procedure to familiarise residents with the importance of understanding surgical anatomy and essential surgical skills. The European Hernia Society’s updated guideline for the treatment of inguinal hernia in adult patients recommends either the open or laparo-endoscopic approach—providing the surgeon has expertise in that approach—as best-evidence based options for IHR [ 2 , 3 ].…”

Section: Introductionmentioning

confidence: 99%

Learning inguinal hernia repair? A survey of current practice and of preferred methods of surgical residents

Nazari

Dankbaar

Sanders

et al. 2020

Hernia

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Purpose During surgical residency, many learning methods are available to learn an inguinal hernia repair (IHR). This study aimed to investigate which learning methods are most commonly used and which are perceived as most important by surgical residents for open and endoscopic IHR. Methods European general surgery residents were invited to participate in a 9-item web-based survey that inquired which of the learning methods were used (checking one or more of 13 options) and what their perceived importance was on a 5-point Likert scale (1 = completely not important to 5 = very important). Results In total, 323 residents participated. The five most commonly used learning methods for open and endoscopic IHR were apprenticeship style learning in the operation room (OR) (98% and 96%, respectively), textbooks (67% and 49%, respectively), lectures (50% and 44%, respectively), video-demonstrations (53% and 66%, respectively) and journal articles (54% and 54%, respectively). The three most important learning methods for the open and endoscopic IHR were participation in the OR [5.00 (5.00–5.00) and 5.00 (5.00–5.00), respectively], video-demonstrations [4.00 (4.00–5.00) and 4.00 (4.00–5.00), respectively], and hands-on hernia courses [4.00 (4.00–5.00) and 4.00 (4.00–5.00), respectively]. Conclusion This study demonstrated a discrepancy between learning methods that are currently used by surgical residents to learn the open and endoscopic IHR and preferred learning methods. There is a need for more emphasis on practising before entering the OR. This would support surgical residents’ training by first observing, then practising and finally performing the surgery in the OR.

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“…The LC for OIHRs (Lichtenstein) has been most accurately estimated to be 40–64 cases 18,19 . A range between 18 and 110 cases was shown to be required for UK trainees to demonstrate competence with OIHRs, 18 indicating the variance in surgical trainees LC trajectories.…”

Section: Discussionmentioning

confidence: 99%

Australian general surgical trainee experience with inguinal hernia surgery: a review of international training programmes and the learning curve

Giddings

Fenton‐Lee

2021

ANZ Journal of Surgery

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Background There are no publications addressing the level of experience Australian surgical trainees achieve in inguinal hernia surgery. Internationally, some training boards have set minimum competency requirements, but this is not true in Australia. The longer learning curve for laparoscopic inguinal hernia repairs (LIHRs) compared to open inguinal hernia repairs (OIHRs) has placed greater demands on trainees. Methods Logbook data on OIHR and LIHR for Australian surgical trainees who graduated as fellows between 2013 and 2018 were obtained. A literature review was performed to analyse international published logbook numbers for surgical trainees from the past decade. International training board requirements, estimations of the learning curve and hernia society guidelines for each procedure were reviewed. Results In total, 7946 operations were recorded from 58 trainees. On average 49.2 OIHRs (range 13–101), 21.5 LIHRs (range 1–94) and 71.1 inguinal hernia repairs overall (range 25–129) were performed during training. The European Hernia Society recommends that at least 30–50 of each procedure be performed during training. The learning curves for LIHRs (50–100 procedures) have been shown to be longer than for OIHRs (40–64 procedures). Conclusion Australian general surgical trainees are achieving adequate primary operator logbook numbers for OIHRs but are not completing the required number of LIHRs. The tailored approach to inguinal hernia repair requires skill in both open and laparoscopic repairs. This may not be possible with the current training structure in Australia.

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Learning curve in open inguinal hernia repair: a quality improvement multicentre study about Lichtenstein technique

Cited by 53 publications

References 20 publications

Learning curve analysis of robotic transabdominal preperitoneal inguinal hernia repair

Learning curve analysis of robotic transabdominal preperitoneal inguinal hernia repair

Learning inguinal hernia repair? A survey of current practice and of preferred methods of surgical residents

Australian general surgical trainee experience with inguinal hernia surgery: a review of international training programmes and the learning curve

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