Standardization and learning curve in laparoscopic hernia repair: experience of a high-volume center

Abstract

Purpose Groin hernias are a common condition that can be treated with various surgical techniques, including open surgery and laparoscopic approaches. Laparoscopic surgery has several advantages but its use is limited due to the complexity of the posterior inguinal region and the need for advanced laparoscopic skills. This paper presents a standardized and systematic approach to trans-abdominal pre-peritoneal (TAPP) groin hernioplasty, which is useful for training young surgeons. Methods The paper provides a detailed, step-by-step description of the TAPP based on evidence from literature, anatomical knowledge, and the authors’ experience spanning over 30 years. The sample includes 487 hernia repair procedures, with 319 surgeries performed by experienced surgeons and 168 surgeries performed by young surgeons in training. The authors performed a descriptive analysis of their data to provide an overview of the volume of laparoscopic hernioplasty performed. Results The analysis of the data shows a low complication rate of 0.41% (2/487) and a low recurrence rate of 0.41% (2/487). The median duration of the surgery was 55 min, while the median operation time for surgeons in training was 93 min, specifically 83 min for unilateral hernia and 115 min for bilateral hernia. Conclusions The TAPP procedure appears, to date, comparable to the open inguinal approach in terms of recurrence, postoperative pain and speed of postoperative recovery. In this paper, the authors challenge the belief that TAPP is not suitable for surgeons in training. They advocate for a training pathway that involves gradually building surgical skills and expertise. This approach requires approximately 100 procedures to achieve proficiency.

A retrospective noninferiority study of laparoscopic inguinal hernia repair feasibility for recently graduated surgeons in Thailand

“…Our study reported a higher complication rate compared with reports from a high-volume center in Europe. Specifically, our study documented a 19.0% postoperative complication rate (4 of 21), whereas the high-volume center reported a significantly lower rate (0.41%) [ 23 ]. Notably, the complications in our study were predominantly minor, with only one of four cases requiring intervention under general anesthesia.…”

Comparison of modified tumescent and conventional laparoscopic transabdominal preperitoneal inguinal hernia repair: a retrospective clinical study

“…4 However, laparoendoscopic repair can be challenging for inexperienced surgeons and trainees because of its steeper learning curve and technical difficulties. 5,6 Approximately 100 cases of supervised laparoendoscopic repair are required to attain outcomes comparable to those achieved with open mesh surgery, such as the Lichtenstein technique. 4 The procedure requires unique skills and a thorough understanding of the anatomy of the inguinal region.…”

In vivo comparison of mesh fixation solutions in open and laparoscopic procedures for inguinal hernia repair: A meta-analysis

“…This approach is beneficial for complex or recurrent hernias but requires a longer recovery and it is associated with a higher risk of complications like infections. In contrast, laparoscopic surgery (LS) is minimally invasive, utilizing small incisions, it can offer the advantages of reduced pain, quicker recovery, and lower complication risks [ 5 ]. Robotic surgery (RS) combines advantages of open and laparoscopic methods, offering enhanced visualization and precision.…”