Standardization and learning curve in laparoscopic hernia repair: experience of a high-volume center

BMC Surgery

Research

Emilia Masci¹  Davide Ferrara¹  Luca Bottero¹  Giuseppe G. Faillace²  Francesco Brucchi³  Federica Ferraina³ 

[1] Department of General Surgery, Edoardo Bassini Hospital, Cinisello Balsamo, MI, Italy;Department of General Surgery, Sesto San Giovanni Hospital, Viale Matteotti, 83, 20099, Milan, MI, Italy;Department of General Surgery, Sesto San Giovanni Hospital, Viale Matteotti, 83, 20099, Milan, MI, Italy;Department of General Surgery, Edoardo Bassini Hospital, Cinisello Balsamo, MI, Italy;

关键词: Inguinal hernia;    TAPP;    Transabdominal preperitoneal;    Critical view of safety;    Mesh;    Groin hernia;    Laparoscopy;   

DOI  :  10.1186/s12893-023-02119-y

 received in 2023-04-27, accepted in 2023-07-22,  发布年份 2023

来源: Springer

【 摘 要 】

PurposeGroin hernias are a common condition that can be treated with various surgical techniques, including open surgery and laparoscopic approaches. Laparoscopic surgery has several advantages but its use is limited due to the complexity of the posterior inguinal region and the need for advanced laparoscopic skills. This paper presents a standardized and systematic approach to trans-abdominal pre-peritoneal (TAPP) groin hernioplasty, which is useful for training young surgeons.MethodsThe paper provides a detailed, step-by-step description of the TAPP based on evidence from literature, anatomical knowledge, and the authors’ experience spanning over 30 years. The sample includes 487 hernia repair procedures, with 319 surgeries performed by experienced surgeons and 168 surgeries performed by young surgeons in training. The authors performed a descriptive analysis of their data to provide an overview of the volume of laparoscopic hernioplasty performed.ResultsThe analysis of the data shows a low complication rate of 0.41% (2/487) and a low recurrence rate of 0.41% (2/487). The median duration of the surgery was 55 min, while the median operation time for surgeons in training was 93 min, specifically 83 min for unilateral hernia and 115 min for bilateral hernia.ConclusionsThe TAPP procedure appears, to date, comparable to the open inguinal approach in terms of recurrence, postoperative pain and speed of postoperative recovery. In this paper, the authors challenge the belief that TAPP is not suitable for surgeons in training. They advocate for a training pathway that involves gradually building surgical skills and expertise. This approach requires approximately 100 procedures to achieve proficiency.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

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