Original Article

J Minim Invasive Surg 2015; 18(4): 127-132

Published online December 15, 2015

https://doi.org/10.7602/jmis.2015.18.4.127

© The Korean Society of Endo-Laparoscopic & Robotic Surgery

The Learning Curve of the Beginner Surgeon with Supervisor for Laparoscopic Totally Extraperitoneal Repair

Jaeho Lee, M.D., Myung-Jin Kim, M.D., Kyung-Yul Hur, M.D., Ph.D.

Department of Surgery, College of Medicine, Soonchunhyang University, Seoul, Korea

Correspondence to : Kyung-Yul Hur
Department of Surgery, Soonchunhyang University Hospital, 59, Daesagwan-ro, Yongsan-gu, Seoul 04401, Korea
Tel: +82-2-709-9114 Fax: +82-2-749-0449 E-mail: hurusa@hanmail.net

Received: August 31, 2015; Revised: October 28, 2015; Accepted: November 2, 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Purpose: Despite acceptance of laparoscopic totally extraperitoneal (TEP) repair for repair of inguinal hernia, it is still considered to require a prolonged learning curve. We hypothesized that there would be differences in the learning curve for laparoscopic TEP repair among beginner surgeons with or without a supervisor. The current study was conducted to observe the learning curve for laparoscopic TEP repair performed by a surgeon without a supervisor.
Methods: A retrospective analysis of the consecutive 143 patients was conducted to document patients’ demographics, hernia types, operative time, and operative outcomes after the operation. Patients were divided into 7 consecutive groups, each comprising 20 patients.
Results: The mean age of the study population was 52.5 years (± 18.9 SD), ranging from 16 to 89 years. The learning curve of this technique was almost horizontal throughout the time course. The mean operative time was quite stable among each group. Comparison of the mean operation time and the length of hospital stay among each group did not show significant differences. There was one recurrence in group V.
Conclusion: The learning curve for laparoscopic TEP repair is not that prolonged if there is an experienced specialized supervisor and opportunities to observe the entire procedure performed by the supervisor are available. It is not the laparoscopic instrument skills but the way the procedure is performed that is important for successful outcomes.

Keywords Laparoscopic TEP repair, Inguinal hernia, Learning curve

  1. Liem M, Halsema JA, van der Graaf Y, Schrijvers AJ, van Vroonhoven TJ. Cost-effectiveness of extraperitoneal laparoscopic inguinal hernia repair: a randomized comparison with conventional herniorrhaphy. Ann Surg 1997;226:668-676.
    Pubmed KoreaMed CrossRef
  2. Heikkinen TJ, Haukipuro K, Koivukangus P, Hulkko A. A prospective randomized outcome and cost comparison of totally extraperitoneal endoscopic hernioplasty versus Lichtenstein hernia operation among employed patients. Surg Laparosc Endosc Percutan Tech 1998;8:338-344.
    CrossRef
  3. Chung RS, Rowland DY. Meta-analyses of randomized controlled trials of laparoscopic vs conventional inguinal hernia repairs. Surg Endosc 1999;13:689-694.
    CrossRef
  4. Feliu-Pala X, Martin-Gomez M, Morales-Conde S, FernandezSallent E. The impact of the surgeon’s experience on the results of laparoscopic hernia repair . Surg Endosc 2001;15:1467-1470.
    Pubmed CrossRef
  5. Voitk AJ. The learning curve in laparoscopic inguinal hernia repair for the community general surgeon. Can J Surg 1998;41:446-450.
    Pubmed KoreaMed
  6. Edwards CC, Bailey RW. Laparoscopic hernia repair: the learning curve. Surg Laparosc Endosc Percutan Tech 2000;10:149-153.
    CrossRef
  7. Lau H, Patil NG, Yuen WK, Lee F. Learning curve for unilateral endoscopic totally extraperitoneal (TEP) inguinal hernioplast. Surg Endosc 2002;16:1724-1728.
    Pubmed CrossRef
  8. Heidenberg J, Kendrick ML, Meile T, Farley DR. Totally extraperitoneal (TEP) approach for inguinal hernia: the favorable learning curve for trainees. Curr Surg 2003;60:65-68.
    CrossRef
  9. Choi YY, Kim Z, Hur KY. Learning curve for laparoscopic totally extraperitoneal repair of inguinal hernia. Can J Surg 2012;55:33- 36.
    Pubmed KoreaMed CrossRef
  10. Kim MJ, Hur KY. Laparoscopic totally extraperitoneal inguinal hernia repair: 10-year experience of a single surgeon. Surg Laparosc Endosc Percutan Tech 2013;23:51-54.
    Pubmed CrossRef
  11. EU Hernia Trialists Collaboration. Laparoscopic compared with open methods of groin hernia repair: systematic review of randomized controlled trials. Br J Surg 2000; 87:860-867.
    Pubmed CrossRef
  12. Liem MSL, van der Graaf Y, van Steensel CJ, et al. Comparision of conventional anterior surgery and laparoscopic surgery for inguinal hernia repair. N Engl J Med 1997;336:1541-1547.
    Pubmed CrossRef
  13. Lichtenstein IL, Shulman AG, Amid PK. Laparoscopic hernioplasty. Arch Surg 1991;126:1449.
    Pubmed CrossRef
  14. Liem MS, van Steensel CJ, Boelhouwer RU, et al. The learning curve for totally extraperitoneal laparoscopic inguinal hernia repair. Am J Surg 1996;171:281-285.
    CrossRef
  15. Swanstrom LL. Laparoscopic Herniorrhaphy. Surg Cl N Am 1996;76:483-491.
    CrossRef
  16. Argote L, Epple D. Learning curves in manufacturing. Science 1990;247:920-924.
    Pubmed CrossRef
  17. Moore MJ, Bennett CL. The learning curve for laparoscopic cholecystectomy. The Southern Surgeons Club. Am J Surg 1995;170: 55-59.
    CrossRef
  18. Schlachta CM, Mammzza J, Seshadri PA, Cadeddu M, Gregoire R, Poulin EC. Defining a learning curve for laparoscopic colorectal resections. Dis Colon Rectum 2001;44:217-222.
    Pubmed CrossRef
  19. Kim MC, Jung GJ, Kim HH. Learning curve of laparoscopy assisted distal gastrectomy with systemic lymphadenectomy for early gastric cancer. World J Gastroenterol 2005;11:7508-7511.
    Pubmed KoreaMed CrossRef
  20. Lal P, Kajla RK, Chander J, Ramteke VK. Laparoscopic total extraperitoneal (TEP) inguinal hernia repair: overcoming the learning curve. Surg Endosc 2004;18:642-645.
    Pubmed CrossRef

Article

Original Article

J Minim Invasive Surg 2015; 18(4): 127-132

Published online December 15, 2015 https://doi.org/10.7602/jmis.2015.18.4.127

Copyright © The Korean Society of Endo-Laparoscopic & Robotic Surgery.

The Learning Curve of the Beginner Surgeon with Supervisor for Laparoscopic Totally Extraperitoneal Repair

Jaeho Lee, M.D., Myung-Jin Kim, M.D., Kyung-Yul Hur, M.D., Ph.D.

Department of Surgery, College of Medicine, Soonchunhyang University, Seoul, Korea

Correspondence to:Kyung-Yul Hur
Department of Surgery, Soonchunhyang University Hospital, 59, Daesagwan-ro, Yongsan-gu, Seoul 04401, Korea
Tel: +82-2-709-9114 Fax: +82-2-749-0449 E-mail: hurusa@hanmail.net

Received: August 31, 2015; Revised: October 28, 2015; Accepted: November 2, 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose: Despite acceptance of laparoscopic totally extraperitoneal (TEP) repair for repair of inguinal hernia, it is still considered to require a prolonged learning curve. We hypothesized that there would be differences in the learning curve for laparoscopic TEP repair among beginner surgeons with or without a supervisor. The current study was conducted to observe the learning curve for laparoscopic TEP repair performed by a surgeon without a supervisor.
Methods: A retrospective analysis of the consecutive 143 patients was conducted to document patients’ demographics, hernia types, operative time, and operative outcomes after the operation. Patients were divided into 7 consecutive groups, each comprising 20 patients.
Results: The mean age of the study population was 52.5 years (± 18.9 SD), ranging from 16 to 89 years. The learning curve of this technique was almost horizontal throughout the time course. The mean operative time was quite stable among each group. Comparison of the mean operation time and the length of hospital stay among each group did not show significant differences. There was one recurrence in group V.
Conclusion: The learning curve for laparoscopic TEP repair is not that prolonged if there is an experienced specialized supervisor and opportunities to observe the entire procedure performed by the supervisor are available. It is not the laparoscopic instrument skills but the way the procedure is performed that is important for successful outcomes.

Keywords: Laparoscopic TEP repair, Inguinal hernia, Learning curve

References

  1. Liem M, Halsema JA, van der Graaf Y, Schrijvers AJ, van Vroonhoven TJ. Cost-effectiveness of extraperitoneal laparoscopic inguinal hernia repair: a randomized comparison with conventional herniorrhaphy. Ann Surg 1997;226:668-676.
    Pubmed KoreaMed CrossRef
  2. Heikkinen TJ, Haukipuro K, Koivukangus P, Hulkko A. A prospective randomized outcome and cost comparison of totally extraperitoneal endoscopic hernioplasty versus Lichtenstein hernia operation among employed patients. Surg Laparosc Endosc Percutan Tech 1998;8:338-344.
    CrossRef
  3. Chung RS, Rowland DY. Meta-analyses of randomized controlled trials of laparoscopic vs conventional inguinal hernia repairs. Surg Endosc 1999;13:689-694.
    CrossRef
  4. Feliu-Pala X, Martin-Gomez M, Morales-Conde S, FernandezSallent E. The impact of the surgeon’s experience on the results of laparoscopic hernia repair . Surg Endosc 2001;15:1467-1470.
    Pubmed CrossRef
  5. Voitk AJ. The learning curve in laparoscopic inguinal hernia repair for the community general surgeon. Can J Surg 1998;41:446-450.
    Pubmed KoreaMed
  6. Edwards CC, Bailey RW. Laparoscopic hernia repair: the learning curve. Surg Laparosc Endosc Percutan Tech 2000;10:149-153.
    CrossRef
  7. Lau H, Patil NG, Yuen WK, Lee F. Learning curve for unilateral endoscopic totally extraperitoneal (TEP) inguinal hernioplast. Surg Endosc 2002;16:1724-1728.
    Pubmed CrossRef
  8. Heidenberg J, Kendrick ML, Meile T, Farley DR. Totally extraperitoneal (TEP) approach for inguinal hernia: the favorable learning curve for trainees. Curr Surg 2003;60:65-68.
    CrossRef
  9. Choi YY, Kim Z, Hur KY. Learning curve for laparoscopic totally extraperitoneal repair of inguinal hernia. Can J Surg 2012;55:33- 36.
    Pubmed KoreaMed CrossRef
  10. Kim MJ, Hur KY. Laparoscopic totally extraperitoneal inguinal hernia repair: 10-year experience of a single surgeon. Surg Laparosc Endosc Percutan Tech 2013;23:51-54.
    Pubmed CrossRef
  11. EU Hernia Trialists Collaboration. Laparoscopic compared with open methods of groin hernia repair: systematic review of randomized controlled trials. Br J Surg 2000; 87:860-867.
    Pubmed CrossRef
  12. Liem MSL, van der Graaf Y, van Steensel CJ, et al. Comparision of conventional anterior surgery and laparoscopic surgery for inguinal hernia repair. N Engl J Med 1997;336:1541-1547.
    Pubmed CrossRef
  13. Lichtenstein IL, Shulman AG, Amid PK. Laparoscopic hernioplasty. Arch Surg 1991;126:1449.
    Pubmed CrossRef
  14. Liem MS, van Steensel CJ, Boelhouwer RU, et al. The learning curve for totally extraperitoneal laparoscopic inguinal hernia repair. Am J Surg 1996;171:281-285.
    CrossRef
  15. Swanstrom LL. Laparoscopic Herniorrhaphy. Surg Cl N Am 1996;76:483-491.
    CrossRef
  16. Argote L, Epple D. Learning curves in manufacturing. Science 1990;247:920-924.
    Pubmed CrossRef
  17. Moore MJ, Bennett CL. The learning curve for laparoscopic cholecystectomy. The Southern Surgeons Club. Am J Surg 1995;170: 55-59.
    CrossRef
  18. Schlachta CM, Mammzza J, Seshadri PA, Cadeddu M, Gregoire R, Poulin EC. Defining a learning curve for laparoscopic colorectal resections. Dis Colon Rectum 2001;44:217-222.
    Pubmed CrossRef
  19. Kim MC, Jung GJ, Kim HH. Learning curve of laparoscopy assisted distal gastrectomy with systemic lymphadenectomy for early gastric cancer. World J Gastroenterol 2005;11:7508-7511.
    Pubmed KoreaMed CrossRef
  20. Lal P, Kajla RK, Chander J, Ramteke VK. Laparoscopic total extraperitoneal (TEP) inguinal hernia repair: overcoming the learning curve. Surg Endosc 2004;18:642-645.
    Pubmed CrossRef

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