Laparoscopic percutaneous extraperitoneal closure for inguinal hernia: learning curve for attending surgeons and residents

Yoshizawa, Jyoji; Ashizuka, Syuichi; Kuwashima, Naruo; Kurobe, Masashi; Tanaka, Keichiro; Ohashi, Shinsuke; Hiramatsu, Tomomasa; Baba, Yuji; Kanamori, Daisuke; Kaji, Sayuri; Ohki, Takao

doi:10.1007/s00383-013-3337-1

Cited by 40 publications

(21 citation statements)

References 10 publications

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“…Yoshizawa et al also reported the learning curve of LPEC with the conclusion that residents require about 30 operations to perform LPEC safely, which was fewer times than our results [7]. It was because their standard point was 30 min, which was more lenient than our study.…”

Section: Discussionmentioning

confidence: 41%

The learning curve of laparoscopic percutaneous extraperitoneal closure (LPEC) for inguinal hernia: protocoled training in a single center for six pediatric surgical trainees

et al. 2019

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BackgroundLaparoscopic percutaneous extraperitoneal closure (LPEC) has become a common procedure for repairing inguinal hernia. As a laparoscopic approach, pediatric surgical trainees require more training to learn LPEC than a traditional open approach. This study aimed to clarify the experience needed to acquire the skill to perform LPEC adequately.MethodsThis descriptive single-center study used clinical data from patients who underwent LPEC between May 2009 and May 2016. The mean operative time for ten consecutive unilateral repairs was used as an index of proficiency with the procedure. The number of repairs performed before the mean operative time became less than 20 min was evaluated for each trainee.ResultsDuring the study period, six pediatric surgical trainees participated in the training independently. The number of the patients was 987. The total number of repairs was 1436, including 538 unilateral repairs and 449 concurrent bilateral repairs. Overall, the mean operative time was 21.8 ± 8.1 min for unilateral repair and 31.4 ± 9.7 min for concurrent bilateral repairs. The mean number of repairs performed before the acquisition of skill for dexterous LPEC was 125.1 ± 29.5.ConclusionsAlthough there were individual differences, all trainees acquired the skill to perform LPEC adequately within one year. With appropriate guidance, LPEC can become a standard technique for pediatric surgical trainees, along with traditional open surgery. These results provide valuable information for planning LPEC training.

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Section: Discussionmentioning

confidence: 41%

The learning curve of laparoscopic percutaneous extraperitoneal closure (LPEC) for inguinal hernia: protocoled training in a single center for six pediatric surgical trainees

et al. 2019

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“…In spite of this being a relatively new technique to the two surgeons, our excellent results illustrate the ease of learning and mastering our technique. Yoshizawa et al [16] found a similar learning curve using their technique with attending surgeons requiring 12 cases to become proficient and safe.…”

Section: Discussionmentioning

confidence: 90%

Laparoscopic needle-assisted inguinal hernia repair in 495 children

et al. 2014

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Minimally invasive surgery for inguinal hernia repair in children has been a controversial topic for pediatric surgeons. Our method for inguinal hernia repair using laparoscopic techniques has comparable outcomes to the standard open technique. We describe our technique and experience with the laparoscopic needle-assisted repair of inguinal hernia (LNAR). We report 502 cases (710 hernias) from 2009 to 2013 by 3 surgeons. We reviewed our prospectively collected outcomes database of all patients receiving LNAR from 1/2009 to 3/2013. 502 cases in 495 patients <13 years old with 710 inguinal hernias were identified for analysis and review. Hernia repair is accomplished with a single-port needle-assisted technique. After identification of a patent processus vaginalis, the internal ring is encircled in an extraperitoneal plane using a 22G-Touhy needle for placement of a purse-string suture, tied extracorporally, and buried beneath the skin. The technique was standardized for all cases. 710 inguinal hernias were laparoscopically repaired in 495 patients (408 boys and 87 girls) age range 11 days to 12.8 years (mean 29.2 months; median 15.5 months). 294 patients had unilateral repair (199R and 95L) and 208 had bilateral repair. Mean operating time for unilateral was 20.5 min, and bilateral was 26.4 min. 21 minor complications were identified (9 superficial wound infections, 8 suture granulomas, and 4 recurrent hydroceles) and 4 recurrences. Mean time since surgery is 30 months (3-54 months). Mean follow-up was 10.7 months (0.3-38.4 months). Post-operative data show our technique is safe with a 4 % rate of minor complication. Recurrence rate was 0.56 % for the total number of hernias (4/710). This recurrence rate is comparable and in many cases less than open technique. Furthermore, laparoscopy objectively identifies asymptomatic or occult contralateral defect, uses a smaller incision, and eliminates dissection of the cord structures potentially reducing the risk of cord injury.

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“…Recently, there is a trend for increased reports of extraperitoneal closure because of its ease of use and good results [24]. In particular, LPEC, reported by Takehara et al [4], is performed widely in Japan [10,11,[13][14][15]. There have been some comparisons between traditional open herniorrhaphy and laparoscopic repair, including a randomized study and a systematic review.…”

Section: Discussionmentioning

confidence: 99%

“…The concept of laparoscopic hernia repair can be divided into two groups. The first group is intraperitoneal internal ring suturing [1][2][3], and the second is extraperitoneal closure [4][5][6][7][8][9][10][11][12][13][14][15]. Recently, there is a trend for increased reports of extraperitoneal closure because of its ease of use and good results.…”

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confidence: 99%

Comparison of percutaneous extraperitoneal closure (LPEC) and open repair for pediatric inguinal hernia: experience of a single institution with over 1000 cases

et al. 2015

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Laparoscopic percutaneous extraperitoneal closure for inguinal hernia: learning curve for attending surgeons and residents

Abstract: Our learning curve analysis showed that whereas attending surgeons needed a mean of 12 operations to perform LPEC repairs safely in 30 min or less, residents needed more than 30 operations to safely perform LPEC repairs without supervision.

Cited by 40 publications

References 10 publications

The learning curve of laparoscopic percutaneous extraperitoneal closure (LPEC) for inguinal hernia: protocoled training in a single center for six pediatric surgical trainees

The learning curve of laparoscopic percutaneous extraperitoneal closure (LPEC) for inguinal hernia: protocoled training in a single center for six pediatric surgical trainees

Laparoscopic needle-assisted inguinal hernia repair in 495 children

Comparison of percutaneous extraperitoneal closure (LPEC) and open repair for pediatric inguinal hernia: experience of a single institution with over 1000 cases

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