Surgeon utilization of minimally invasive techniques for inguinal hernia repair: a population-based study

Vu, Joceline V.; Gunaseelan, Vidhya; Krapohl, Greta L.; Englesbe, Michael J.; Campbell, Darrell A.; Dimick, Justin B.; Telem, Dana A.

doi:10.1007/s00464-018-6322-x

Cited by 39 publications

(20 citation statements)

References 28 publications

(31 reference statements)

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“…Even though it is hardly used in regions with limited health resources, TAPP laparoscopic correction has recurrence rates equal to or lower than previous repairs associated with the benefit of low morbidity with rapid work return 15 . Transabdominal preperitoneal inguinal hernia repair rates range from 10 to 48% 16 , and almost half of surgeons had never performed laparoscopic repair, corroborated by this study, in which only two surgeons in training had performed / assisted a laparoscopic hernia 13 .…”

Section: Discussionsupporting

confidence: 70%

Simulated training model in a low cost for laparoscopic inguinal hernioplasty

et al. 2021

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Purpose: Develop a 3D model for the simulation of laparoscopic inguinal hernioplasty transabdominal preperitoneal (TAPP). Methods: This is an experimental study, 18 participants were selected, divided into three groups, experimental (GE) surgeons in training, control (GC) experienced surgeons and Shaw (GS) nonexperienced surgeons. The simulation in the 3D model was carried out in 6 sessions fulfilling the 5 stages. Opening the peritoneum with the creation of the preperitoneal space; identification of important structures; hernia identification and reduction; placement and fixation of the mesh in Cooper's ligament and closure of the peritoneum. Results: In the 1st stage, the GE obtained an average of 1.25 ± 0.42 in the 1st session and 3.25 ± 0.62 in the 6th session (p = 0.05) and in the 5th stage 0.91 ± 0.29 in the first session. 1st session and 1.91 ± 0.29 in the 6th session (p = 0.001), with no significant difference between groups. The learning and skill curve in the SG represented 1.08 ± 0.29 1st and 3.50 ± 0.90 6th session (p = 0.001). Conclusion: The creation of a systematization of training in simulation applied to the three-dimensional model enabled gain in laparoscopic skills and underpinned its theoretical and practical foundations.

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Section: Discussionsupporting

confidence: 70%

Simulated training model in a low cost for laparoscopic inguinal hernioplasty

et al. 2021

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“…1 While most surgeons use an open approach, there has been a growth in laparoscopic and robotic techniques among unilateral, bilateral, and recurrent hernia repairs. 2,3 Advantages have been lauded, with laparoscopic and robotic repair allowing for superior visualization of bilateral groin anatomy and exploration of both inguinal and femoral spaces. Also, some reports suggest that patients may have less postoperative pain.…”

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confidence: 99%

Clinical and Cost Outcomes of Robot-Assisted Inguinal Hernia Repair: A Systematic Review

Tang

Shenoy

et al. 2021

Journal of the American College of Surgeons

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Inguinal hernia repair is one of the most common general surgical procedures, with more than 20 million hernias repaired worldwide annually. 1 While most surgeons use an open approach, there has been a growth in laparoscopic and robotic techniques among unilateral, bilateral, and recurrent hernia repairs. 2,3 Advantages have been lauded, with laparoscopic and robotic repair allowing for superior visualization of bilateral groin anatomy and exploration of both inguinal and femoral spaces. Also, some reports suggest that patients may have less postoperative pain. 4 A recent study found that robotic inguinal hernia repair use increased 41-fold in Michigan (2012 to 2018). 5 Proponents of the robotic platform argue that its magnified 3-dimensional visualization, stable platform, and superior range of motion may translate into better clinical outcomes. 6 The number of robotic inguinal hernia repair procedures continues to rise despite confirmation of the clinical benefits. 7,8 The economic value of robotic surgery is also unclear. Technology acquisition and implementation require substantial upfront investment along with ongoing costs for annual maintenance contracts, instrument purchases, staff and training, infrastructure upgrades, and marketing. 9 The cost benefit in relationship to clinical outcomes associated with the use of robotic technology must be apparent to provider and patient.Two systematic reviews of robotic inguinal hernia repair were published in 2019 but are already dated, as at least 10 additional studies have since been published, including the first randomized controlled trial (RCT). 10,11 We proceeded with this systematic review to provide the most up-to-date assessment of perioperative and long-term clinical outcomes and cost for robotassisted inguinal hernia repair compared with open and laparoscopic approaches. METHODSThis review is part of a larger report commissioned by the Department of Veterans Affairs on the clinical outcomes and cost-effectiveness of robotic procedures for cholecystectomy, inguinal hernia repair, and ventral hernia repair. This systematic review is reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards, 12 and the a priori protocol was registered in PROSPERO: CRD42020156945.

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“…Three implementation strategies were ultimately selected based on identified barriers and facilitators, sources of behavior from linkage of theoretical framework domains to behavior change theories, results of prior successful strategies deployed through the MSQC, and established resources available within the MSQC. 25,29,30 Stepwise Implementation of Evidence-Based Interventions at a Pilot Level…”

Section: Identifying Evidence-based Implementation Strategiesmentioning

confidence: 99%

Development and Implementation of Preoperative Optimization for High-Risk Patients With Abdominal Wall Hernia

et al. 2021

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IMPORTANCE Real-world surgical practice often lags behind the best scientific evidence. For example, although optimizing comorbidities such as smoking and morbid obesity before ventral and incisional hernia repair improves outcomes, as many as 25% of these patients have a high-risk characteristic at the time of surgery. Implementation strategies may effectively increase use of evidence-based practice.OBJECTIVE To describe current trends in preoperative optimization among patients undergoing ventral hernia repair, identify barriers to optimization, develop interventions to address these barriers, and then pilot these interventions. DESIGN, SETTING, AND PARTICIPANTSThis quality improvement study used a retrospective medical record review to identify hospital-level trends in preoperative optimization among patients undergoing ventral and incisional hernia repair. Semistructured interviews with 21 practicing surgeons were conducted to elicit barriers to optimizing high-risk patients before surgery. Next, a task force of experts was convened to develop pragmatic interventions to increase surgeon use of preoperative optimization. Finally, these interventions were piloted at 2 sites to assess acceptability and feasibility. This study was performed from January 1, 2014, to December 31, 2019. MAIN OUTCOMES AND MEASURESThe main outcome was rate of referrals for preoperative patient optimization at the 2 pilot sites. RESULTS Among 23 000 patients undergoing ventral hernia repair, the mean (SD) age was 53.9 (14.3) years, and 12 315 (53.5%) were men. Of these, 8786 patients (38.2%) had at least 1 high-risk characteristic at the time of surgery, including 7683 with 1, 1079 with 2, and 24 with 3. At the hospital level, the mean proportion of patients with at least 1 of 3 high-risk characteristics at the time of surgery was 38.2% (95% CI, 38.1%-38.3%). This proportion varied widely from 21.5% (95% CI, 17.6%-25.5%) to 52.8% (95% CI, 43.9%-61.8%) across hospitals. Interviews with surgeons identified 3 major barriers to improving this practice: lost financial opportunity by not offering a patient an operation, lack of surgeon awareness of available resources for optimization, and organizational barriers. A task force therefore developed 3 interventions: a financial incentive to optimize high-risk patients, an educational intervention to make surgeons aware of available optimization resources, and on-site facilitation. These strategies were piloted at 2 sites where preoperative risk optimization referrals increased 860%. CONCLUSIONS AND RELEVANCEThis study demonstrates a stepwise process of identifying a practice gap, eliciting barriers that contribute to this gap, using expert consensus and local resources to develop strategies to address these barriers, and piloting these strategies. This implementation (continued) Key Points Question Is a stepwise implementation intervention associated with increased use of preoperative optimization by surgeons for patients with abdominal wall hernia? Findings In this quality improvement study in...

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Surgeon utilization of minimally invasive techniques for inguinal hernia repair: a population-based study

Cited by 39 publications

References 28 publications

Simulated training model in a low cost for laparoscopic inguinal hernioplasty

Simulated training model in a low cost for laparoscopic inguinal hernioplasty

Clinical and Cost Outcomes of Robot-Assisted Inguinal Hernia Repair: A Systematic Review

Development and Implementation of Preoperative Optimization for High-Risk Patients With Abdominal Wall Hernia

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