Learning curve takes 65 repetitions of totally extraperitoneal laparoscopy on inguinal hernias for reduction of operating time and complications

Suguita, Fábio Yuji; Essu, Felipe Futema; Oliveira, Lucas Torres; Iuamoto, Leandro Ryuchi; Kato, Juliana Mika; Torsani, Matheus Beloni; Franco, André Silva; Meyer, Alberto; Andraus, Wellington

doi:10.1007/s00464-017-5426-z

Cited by 65 publications

(50 citation statements)

References 24 publications

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“…In addition, surgeons performing SILS must have specific skills, such as the ability to manipulate the laparoscopic instruments in a confined operating space, and they must overcome difficulties related to the in‐line positioning of the laparoscope and the close proximity of the working instruments with limited triangulation and motion. Previous reports suggested that 30–80 cases were needed to master the learning curve for TEP . In the present study, the operating time decreased gradually after 20 cases and stabilized at about 60 min after 40 cases; the rate of peritoneal injury also tended to decrease in the experienced period.…”

Section: Discussionsupporting

confidence: 59%

“…Surgeons performing SILS‐TEP have to overcome the many difficulties associated with a confined operating space, including in‐line positioning of the laparoscope, close proximity of the working instruments with limited triangulation, and the limited range of motion of the laparoscope and instruments. Although a previous report suggested that 30–80 cases were needed to master the learning curve for TEP , there have been no reports on the learning curve for SILS‐TEP. The purpose of this study was to clarify the learning curve for SILS‐TEP using moving averages.…”

Section: Introductionmentioning

confidence: 99%

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Learning curve for single‐incision laparoscopic totally extraperitoneal inguinal hernia repair

Wakasugi

Nakahara

Hirota

et al. 2018

Asian J Endoscop Surgery

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Introduction: The learning curve for totally extraperitoneal repair (TEP) is longer and steeper than that for transabdominal preperitoneal repair (TAPP) due to the preperitoneal view to which the surgeon is not accustomed and the limited working space. The aim of this study was to clarify the learning curve for SILS-TEP.Methods: A retrospective analysis of 80 consecutive patients with unilateral inguinal hernia was performed. All patients underwent elective SILS-TEP performed by a single learning surgeon with a teaching assistant between July 2016 and March 2018 at Kinki Central Hospital.Results: The operative time decreased gradually after 20 cases and stabilized after 40 cases. The first 40 cases were categorized as the learning period group, and the remaining 40 cases were categorized as the experienced period group. More patients received antithrombotic therapy in the experienced period than in the learning period (P < 0.05). The median operative time was 107 and 60 min in the learning period and the experienced period, respectively (P < 0.05). There were no significant differences in blood loss peritoneal injury, conversion to a different procedure, postoperative hospital stay, complications, and recurrence between the two groups. No major complications or hernia recurrence were noted during follow-up. Conclusions:The learning curve for SILS-TEP might take 40 cases to reduce the operative time. SILS-TEP can be performed safely by a learning surgeon with a teaching assistant.

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Section: Discussionsupporting

confidence: 59%

Section: Introductionmentioning

confidence: 99%

Learning curve for single‐incision laparoscopic totally extraperitoneal inguinal hernia repair

Wakasugi

Nakahara

Hirota

et al. 2018

Asian J Endoscop Surgery

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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%

“…[14,15,27] In addition to the need of the sound technical learning and handson training, it is mandatory to acquire precise anatomical knowledge before performing the technically demanding TEPP hernioplasty. [21,27,55,59,[63][64][65] In addition to the technical dexterity, there are some drawbacks for the common adoption of this technique including increased operative times, complications during the early learning curve, and almost absolute necessity for general anaesthesia. [14,15] The easily fissile plane of the preperitoneal surgical dissection was found avascular as long as both fascia & fat was visible on either side of the dissection plane -anteriorly the diaphanous transversalis fascia and posteriorly the preperitoneal fascia covering the preperitoneal fat, suggesting separate embryonic origin of the transversalis fascia (outermost layer) and preperitoneal fascia (intermediate layer), as also documented by Mark Hayes in terms of the outermost layer (transversalis fascia), [66] the intermediate layer (preperitoneal or extraperitoneal fascia) and the innermost layer (peritoneum).…”

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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“…Tension-free repairs are the current methods of choice in groin hernia surgery because they have a more comfortable postoperative course and lower recurrence rates. Tension-free repairs using synthetic material via video-endoscopic interventions are widely accepted in hernia surgery [1]. Transabdominal preperitoneal (TAPP) and total extraperitoneal (TEP) methods with a posterior approach have been implemented as video-endoscopic techniques.…”

Section: Introductionmentioning

confidence: 99%

Video-endoscopic Tension-free Groin Hernia Repair via Total Extraperitoneal Approach

Doğan¹,

Gürleyik²

2020

Cureus

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IntroductionTension-free repair of groin hernias with synthetic material by video-endoscopic surgery is a widely accepted method that is performed by various approaches. We aim to present our results of video-endoscopic tension-free repair of groin hernias via the total extraperitoneal (TEP) approach. MethodsBetween September 2016 and December 2018, 124 patients with groin hernias underwent tension-free repair using prolene mesh by video-endoscopic surgery via the TEP approach. This is a retrospective analysis of 110 (88.7%) male and 14 (11.3%) female patients with a mean age of 48.1 years. Groin hernia types, locations of hernias, intraoperative and postoperative complications, results of the mean 24-month follow-up, and recurrence rate were reported. ResultsA total of 134 hernias were repaired in 124 patients who had 53 (42.7%) right, 61 (49.2%) left, and 10 (8.1%) bilateral groin hernias. The most common hernia type was an indirect inguinal hernia in 83/134 (62%) groin hernias. A total of 119 (88.8%) and 15 (11.2%) hernias were primary and recurrent, respectively. Seroma was detected in two (1.6%) patients in the early postoperative period. The mean duration of hospital stay was 1.4 (1-3) days. During the followup period, hernia recurrence was determined in three (2.4%) patients. Hernia recurrence was detected among patients who were operated on during the first half of the study. ConclusionTension-free repair of groin hernias by video-endoscopic technique via the TEP approach can be performed with very low complication and recurrence rates. The success of the TEP approach increases parallel to increasing surgical experience. The results of hernia repair via the TEP approach are highly satisfactory and encouraging, especially when attention is paid to proper patient selection during the learning curve period.

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Learning curve takes 65 repetitions of totally extraperitoneal laparoscopy on inguinal hernias for reduction of operating time and complications

Abstract: After an initial reduction, the mean operating time stabilised after 65 cases. A reduction in the rate of complications was observed after 35 cases, and a rate of 97% of early discharge was achieved.

Cited by 65 publications

References 24 publications

Learning curve for single‐incision laparoscopic totally extraperitoneal inguinal hernia repair

Learning curve for single‐incision laparoscopic totally extraperitoneal inguinal hernia repair

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

Video-endoscopic Tension-free Groin Hernia Repair via Total Extraperitoneal Approach

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