The impact of the surgeon's experience on the results oflaparoscopic hernia repair

Feliu-Palà, Xavier; Martín-Gómez, M. Adoración; Morales-Conde, Salvador; Fernández-Sallent, Enrique

doi:10.1007/s00464-001-9017-6

Cited by 95 publications

(55 citation statements)

References 18 publications

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“…The mean operating time was 59 min in the first quartile of operations which gradually improved to 37 min in the fourth quartile. He also found Another study by Feliu-pala et al [15] showed that the mean operating time was >60 min for first 50 cases, but there was continuous decreasing trend as the level of experience increased (32 min for last 200 cases). Conversion to open or TAPP also decreased as the surgeons experience increased, being as high as 17 % for the first 100 cases and 2.2 % for the last 500 cases.…”

Section: Discussionmentioning

confidence: 81%

Learning Curve in Laparoscopic Inguinal Hernia Repair: Experience at a Tertiary Care Centre

et al. 2015

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One of the major reasons for laparoscopy not having gained popularity for repair of groin hernia is the perceived steep learning curve. This study was conducted to assess the learning curve and to predict the number of cases required for a surgeon to become proficient in laparoscopic groin hernia repair, by comparing two laparoscopic surgeons. The learning curve evaluation parameters included operative time, conversions, intraoperative complications and postoperative complications, and these were compared between the senior and the junior surgeon. One hundred thirty-eight cases were performed by the senior surgeon, and 63 cases by the junior surgeon. Both were comparable in terms of intraoperative and postoperative complications. Using the moving average method, minimum of 13 laparoscopic hernia repairs are required to reach at par the operating time of an experienced surgeon. For total extraperitoneal (TEP) repair, the number of cases was 14; and for transabdominal preperitoneal (TAPP) repair, this number was 13.

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Section: Discussionmentioning

confidence: 81%

Learning Curve in Laparoscopic Inguinal Hernia Repair: Experience at a Tertiary Care Centre

et al. 2015

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“…It is not clear whether laparoscopic surgery should be a superspecialty for a few surgeons or be performed by all general surgeons. Most surgeons with laparoscopic experience believed that the use of laparoscopic techniques should be generalized, although this issue continues to be controversial [2, 3, 4, 5, 6, 7, 8, 9]. Most of the surgeons who did not carry out advanced laparoscopic procedures pointed to the low number of patients in whom this would be performed, to resource or other local constraints as well as to the unwillingness to learn the procedures.…”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, advanced procedures were performed by only a few surgeons, despite the fact that most hospitals had adequate technical facilities and equipment, presumably due to the lack of evidence of their advantages over open surgery, coupled with the technical difficulty [5, 7, 9, 10]. Thus, the evidence base for advanced laparoscopic surgery needs to be expanded [4], and there should be better opportunities for training both for trainees and practicing specialists.…”

Section: Discussionmentioning

confidence: 99%

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The Development of Laparoscopic Surgery in Spain

Feliu¹,

Targarona²,

García-Agustí³

et al. 2004

Dig Surg

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Aim: To assess degree of development and level of acceptance of laparoscopic surgery in Spain. Method: A questionnaire was sent to all members of the Spanish Association of Surgeons in April 2003. It included 32 questions, 9 of which were general, and 23 referred to specific clinical situations, techniques, and standard practice. Results: Eight hundred and fifty-eight (33.1%) surgeons replied. Only 211 (25%) surgeons reported performing advanced laparoscopic procedures. Four hundred and twenty (49%) surgeons believed that the results obtained with laparoscopic surgery were better than those obtained with conventional surgery, and 325 (40%) surgeons believed that laparoscopy would become a superspecialty. Laparoscopic surgery was considered the method of choice in the treatment of gallbladder stones (99%), gastroesophageal reflux disease (94%), acute cholecystitis (81%), in selected cases of inguinal hernia repair, and in procedures to be performed in spleen and adrenals, benign colon disease, and obesity. Three hundred and ninety-eight (47%) surgeons considered laparoscopic surgery the preferred approach for colon cancer, 292 (34%) for appendicitis, and 155 (18%) for incisional hernia. Five hundred and five (59%) surgeons considered that the use of laparoscopic surgery had grown less than expected. Conclusions: The vast majority of surgeons advocated laparoscopic surgery for the treatment of gallbladder stones and gastroesophageal reflux disease. Although most hospitals had the appropriate technical facilities for performing advanced laparoscopic procedures, few surgeons actually did so.

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“…[51] The Cooperian philosophy is still timely and rather more true in the current laparoscopic era for safe and successful outcome as emphasized recently by Annibali et al and Bhatia, [52,53] and it demands crisp precise flawless anatomical knowledge, [16,26,53] long strenuous laparoscopic learning, [16,21] and significant laparoscopic experience of >30-80 cases, [27,[55][56][57][58][59] for the seamless surgery, and that it also poses new Section: Surgery dangers of modern technological approaches, warranting more anatomic research. [28,33] Anecdotal experiences published in the literature indicate that the fascial arrangements and relationships of structures near the deep inguinal ring are unfamiliar from the laparoscopic perspectives and are not generally known to most of the laparoscopic hernia surgeons.…”

Section: Discussionmentioning

confidence: 99%

Transversalis Fascia and Preperitoneal Fascia: A Laparoscopic Study of Live Surgical Anatomy during TEPP Hernioplasty – Final Report and Literature Review

Ansari¹

2017

AIMDR

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Background: Despite excellent perspective, bright lighting and high magnification afforded by preperitoneal laparoscopy, there is still little agreement among the practicing surgeons and anatomists about transversalis and preperitoneal fascias. Methods: Study Setting -Elective Clinical; Design -Prospective; Population -Adults (≥18 years); Place -J. N. Medical College Hospital, A. M. U., Aligarh; Procedure: Laparoscopic total extraperitoneal preperitoneal (TEPP) hernioplasty; Technique: Standard 3-midline-port technique; Method: Telescopic and instrument dissection; Data collection -Intraoperative documentation and/or video recording; Data analysis -SPSS (v. 21).Results: Sixty eight TEPP hernioplasties (Unilateral TEPP 52; Bilateral 8) were successful in 60 patients. Transversalis fascia was of three types -single diaphanous layer (60%), single membranous layer associated with little/no fat (15%) and thin flimsy layer (25%). Preperitoneal fascia was observed as a definite single membranous layer in 83% of the cases, and as a double membranous layer in the remaining 17%. Internal spermatic fascia was found as an extension analog of the preperitoneal fascia in all cases in the present study, with formation of a secondary internal inguinal ring at its beginning. Easily fissile avascular plane was consistently present between preperitoneal fascia and transversalis fascia, suggesting different embryological origins. Conclusion: Preperitoneal laparoscopy of inguino-pelvic region confirmed regular presence of easily recognizable preperitoneal fascia distinct from transversalis fascia in all cases, with an easily fissile avascular preperitoneal plane in between them. Transversalis fascia was invariably unilaminar but preperitoneal fascia was at times bilaminar. Instead of transversalis fascia, preperitoneal fascia formed internal spermatic sheath with a secondary internal inguinal ring.

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The impact of the surgeon's experience on the results oflaparoscopic hernia repair

Abstract: This study shows that postoperative complications, conversion rate, operating time, and recurrences are all substantially reduced as the surgeon's experience increases. Thus, once the learning curve is surpassed, TEP repair represents a good alternative to open techniques.

Cited by 95 publications

References 18 publications

Learning Curve in Laparoscopic Inguinal Hernia Repair: Experience at a Tertiary Care Centre

Learning Curve in Laparoscopic Inguinal Hernia Repair: Experience at a Tertiary Care Centre

The Development of Laparoscopic Surgery in Spain

Transversalis Fascia and Preperitoneal Fascia: A Laparoscopic Study of Live Surgical Anatomy during TEPP Hernioplasty – Final Report and Literature Review

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