Learning curve of laparoscopic inguinal hernia repair: systematic review, meta-analysis, and meta-regression

Sivakumar, Jonathan; Chen, Qianyu; Hii, Michael W; Cullinan, Mark; CHOI, Julian; Steven, Mark; Crosthwaite, Gary

doi:10.1007/s00464-022-09760-3

Cited by 18 publications

(9 citation statements)

References 82 publications

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“…The European hernia society guidelines reported that the plateau in the LC after laparoscopic TAPP could occur after 50–100 cases [ 13 ]. A recent systematic review, including six studies, found that the median number of procedures required to overcome the LC for laparoscopic TAPP was 37.5 (range 13–75) [ 14 ]. As per the rTAPP, it is more difficult to make such a statement because, as stated above, studies on the topic are limited and heterogeneous in terms of surgeons’ experience both with TAPP and robotic surgery.…”

Section: Discussionmentioning

confidence: 99%

Differences in the learning curve of robotic transabdominal preperitoneal inguinal hernia repair according to surgeon’s robotic experience

Solaini,

Cavaliere,

Rocco

et al. 2023

Hernia

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Purpose In this study, we aim to analyze the learning curve of each step of robotic transabdominal pre-peritoneal inguinal hernia repair (rTAPP) in two surgeons with varying degrees of expertise with the robotic platform but no experience with laparoscopic hernia repair. Methods Data on 124 rTAPP cases performed by two surgeons were retrospectively reviewed. Cumulative sum (CUSUM) analysis was applied to visualize the learning curve of rTAPP on operation time of each step of the procedure [the peritoneal flap creation (T1), the completion of the critical view of the myopectineal orifice (T2), the mesh application (T3) and the peritoneal flap closure (T4)]. Each intraoperative and postoperative outcome was compared according to surgeon’s experience with the robotic platform and learning phase. The robotic surgeon mentored the surgeon-in-training and was present during all surgeries in his learning period. Results The surgeon in training with the robotic platform showed a learning phase till the 20th procedure followed by a gradual improvement in performances. The expert surgeon showed a learning phase till the 35th procedure after which a constant decrease of operative time was recorded till the last procedure included. The operative times of each step of the procedures of both surgeons were significantly improved after the learning phase. In the late phase, the surgeon in training could achieve operative times in T2 and T3, which are similar to those of an experienced robotic surgeon with no experience with TAPP before the completion of the learning phase. Conclusions In conclusion, the learning phase of rTAPP surgery may vary between 20 and 35 cases, depending on the surgeon’s experience in robotic surgery.

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Section: Discussionmentioning

confidence: 99%

Differences in the learning curve of robotic transabdominal preperitoneal inguinal hernia repair according to surgeon’s robotic experience

Solaini,

Cavaliere,

Rocco

et al. 2023

Hernia

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“…These cases were operated on in the first half of the study, possibly related to learning the technique. Previous studies have shown that conversion is greater in the learning phase and that between 30–75 surgeries are required to complete the learning curve [ 38 , 39 ]. The surgeons who performed TEP and TAPP in our study began and completed their learning curve during the time analyzed; however, this learning was not carried out only in bilateral inguinal hernias.…”

Section: Discussionmentioning

confidence: 99%

Bilateral inguinal hernia repair by laparoscopic totally extraperitoneal (TEP) vs. laparoscopic transabdominal preperitoneal (TAPP)

Hidalgo,

Guillaumes,

Bachero

et al. 2023

BMC Surg

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Background The guidelines recommend laparoscopic repair for bilateral inguinal hernia. However, few studies compare the totally extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) techniques in bilateral inguinal hernias. This study aimed to compare the outcomes of TEP and TAPP in bilateral inguinal hernia. Methods We conducted a retrospective cohort study of patients operated on for bilateral inguinal hernia by TEP and TAPP repair from 2016 to 2020. Intraoperative complications, operative time, acute postoperative pain, hospital stay, postoperative complications, chronic inguinal pain, and recurrence were compared. Results A total of 155 patients were included in the study. TEP was performed in 71 patients (46%) and TAPP in 84 patients (54%). The mean operative time was longer in the TAPP group than in the TEP group (107 min vs. 82 min, p < 0.001). The conversion rate to open surgery was higher in the TEP group than in the TAPP group (8.5% vs. 0%, p = 0.008). The mean hospital stay was longer in the TAPP group than in the TEP group (p < 0.001). We did not observe significant differences in the proportion of postoperative complications (p = 0.672), postoperative pain at 24 h (p = 0.851), chronic groin pain (p = 0.593), and recurrence (p = 0.471). We did not observe an association between the choice of surgical technique (TEP vs. TAPP) with conversion rate, operative time, hospital stay, postoperative complications, chronic inguinal pain, or hernia recurrence when performing a multivariable analysis adjusted for the male sex, age, BMI, ASA, recurrent hernia repair, surgeon, and hernia size > 3cm. Conclusions Bilateral inguinal hernia repair by TEP and TAP presented similar outcomes in our study.

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“…These include factors such as obesity (body mass index >35 kg/m 2 ), high American Society of Anesthesiologists (ASA) classification (class 3 or 4), scrotal hernias, strangulated or incarcerated hernias, patients on anticoagulation therapy, and individuals with a history of previous lower abdominal surgery. These factors may pose additional technical and clinical challenges during the TAPP procedure and require careful evaluation and patient selection 9,10 …”

Section: Discussionmentioning

confidence: 99%

“…These factors may pose additional technical and clinical challenges during the TAPP procedure and require careful evaluation and patient selection. 9,10 The learning curve associated with the transperitoneal approach, particularly the TAPP technique, remains a matter of debate. The number of cases required to achieve proficiency in this approach varies significantly between different authors, contributing to the ongoing debate surrounding the definition of a complete learning curve.…”

Section: Discussionmentioning

confidence: 99%

Impact of Umbilicus-Symphysis Pubis Distance on Technical Difficulties in Transabdominal Preperitoneal Hernia Repair (TAPP)

Arici

2023

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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Introduction: Laparoscopic inguinal hernia repair has gained popularity due to its advantages over open procedures. However, technical challenges and anatomical variations can affect surgical outcomes. The umbilicus-symphysis pubis (USP) distance has been identified as a potential factor impacting laparoscopic operations. This study aims to investigate the association between USP distance, technical difficulties, and operative time in the transabdominal preperitoneal (TAPP) surgery. Methods: A retrospective analysis was conducted on 122 patients who underwent elective TAPP surgery. USP distance was measured, and surgical data were collected. Statistical analysis was performed to evaluate the relationship between USP distance and operative time. Results: Among the patients, 80 underwent unilateral hernia repair, and 42 underwent bilateral hernia repair. In unilateral repair, USP distance did not significantly affect operative time. However, in bilateral repair, there was a significant association between USP distance and operation time prolongation (P=0.039). Discussion: TAPP surgery presents challenges due to limited visualization and anatomical variations. Factors like USP distance can impact surgical outcomes. A shorter distance increases complexity, while a longer distance facilitates smoother procedures. Surgeons should consider USP distance during surgical planning to optimize outcomes. Conclusion: The study findings indicate that USP distance is associated with prolonged operative time in TAPP bilateral hernia repair. Surgeons, especially those in the learning phase, can benefit from considering this relationship to optimize surgical outcomes and resource allocation. Further research is needed to validate these findings and explore additional factors influencing operative time in hernia repair surgeries.

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Learning curve of laparoscopic inguinal hernia repair: systematic review, meta-analysis, and meta-regression

Cited by 18 publications

References 82 publications

Differences in the learning curve of robotic transabdominal preperitoneal inguinal hernia repair according to surgeon’s robotic experience

Differences in the learning curve of robotic transabdominal preperitoneal inguinal hernia repair according to surgeon’s robotic experience

Bilateral inguinal hernia repair by laparoscopic totally extraperitoneal (TEP) vs. laparoscopic transabdominal preperitoneal (TAPP)

Impact of Umbilicus-Symphysis Pubis Distance on Technical Difficulties in Transabdominal Preperitoneal Hernia Repair (TAPP)

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