Achieving the Learning Curve in Laparoscopic Inguinal Hernia Repair by Tapp: A Quality Improvement Study

Bracale, Umberto; Merola, Giovanni; Sciuto, Antonio; Cavallaro, Giuseppe; Andreuccetti, Jacopo; Pignata, Giusto

doi:10.1080/08941939.2018.1468944

Cited by 57 publications

(37 citation statements)

References 27 publications

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“…Previous study indicated that more than 100 endoscopic repairs are required to achieve outcomes comparable to open anterior mesh repair [ 5 ]. However, in-line with our results, other articles referred to 65 procedures as a minimum volume necessary to train for endoscopic inguinal hernia repairs [ 30 , 31 ]. Due to this discrepancy between the numbers estimated for proficiency by our surgical residents and the numbers needed for proficiency, the question arises whether surgical residents overestimate themselves, or the trainees underestimate the residents.…”

Section: Discussionsupporting

confidence: 84%

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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Section: Discussionsupporting

confidence: 84%

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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“…Therefore, during the learning curve there is a higher recurrence rates for surgeons until they reach mastery [8,51,52]. Bracale et al [53] published a study comparing 100 TAPP procedures by two different trainees and a senior surgeon. Two tests were used to evaluate completion of the learning curve: The Cumulative Sum (CUSUM) and KPSS tests.…”

Section: Surgeon's Learning Curve Case Load Experience and Frustratmentioning

confidence: 99%

Causes of recurrence in laparoscopic inguinal hernia repair

Siddaiah‐Subramanya

Ashrafi

Memon

et al. 2018

Hernia

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Recurrence can occur at any stage following inguinal hernia surgery. Patients' risk factors such as higher BMI, smoking, diabetes and postoperative surgical site infections increase the risk of recurrence and can be modified. Amongst the surgical factors, surgeon's experience, larger mesh with better tissue overlap and careful surgical techniques to reduce the incidence of seroma or hematoma help reduce the recurrence rate. Other factors including type of mesh and fixation of mesh have not shown any difference in the incidence of recurrence. It is hoped that future randomized controlled trials will address some of these issues and initiate preoperative management strategies to modify some of these risk factors to lower the risk of recurrence following laparoscopic inguinal herniorrhaphy.

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“…The plateau of the LC for both laparoscopic TAPP and TEP procedures varies between 13 and 65 cases. 6,[14][15][16][17] The European Hernia Society guidelines state that the TAPP and totally extra peritoneal inguinal hernia repair LCs peak after experiencing 50-100 cases, with the first 30-50 cases having the highest incidence of complications. 18 Bansal et al reported that the average number for stabilization of the LC was 13 operations for laparoscopic TEP and TAPP.…”

Section: Discussionmentioning

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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Achieving the Learning Curve in Laparoscopic Inguinal Hernia Repair by Tapp: A Quality Improvement Study

Cited by 57 publications

References 27 publications

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

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

Causes of recurrence in laparoscopic inguinal hernia repair

Learning curve analysis of robotic transabdominal preperitoneal inguinal hernia repair

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