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Laparoscopic inguinal hernia repair: impact of surgical time in the learning curve

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Abstract

Purpose

One of the procedures that has become very popular thanks to the advantages of minimally invasive approach is the laparoscopic treatment of inguinocrural hernias. As a disadvantage, it would imply a longer learning curve when compared to the conventional approach. There is no consensus about the number of procedures required to dominate this surgical technique, since according to bibliography it ranges from 20 to 240.

Methods

We analyzed and compared the progress of 18 third year surgical residents while they were introducing into laparoscopic transabdominal preperitoneal inguinal hernioplasties between June 2013 and May 2018.

Results

Between June 2013 and May 2018, 1282 laparoscopic inguinal hernioplasties were performed (71 procedures per resident). Mean surgical time was for unilateral: 62.13 min (SD ± 15.54; range 30–105 min) for the first third (Q1) vs 54.61 min (SD ± 15.38; range 30–100 min) for the last third (Q3): p < 0.0001. For bilateral were: 92.59 min (SD ± 21.89; range 50–160 min) for Q1 vs 84.48 min (SD ± 20.52; range 30–130 min) for Q3: p < 0.05. Accepting an alpha error of 5% and considering an association power of 80%, there would be needed 61 cases per surgeon to achieve a significant reduction in surgical time.

Conclusion

In a center with high-volume in TAPP and under a supervised training program, it is feasible to achieve a reduction in surgical time. Randomized studies with a larger number of cases are necessary to confirm this finding and draw more robust and objective conclusions.

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Authors and Affiliations

  1. General Surgery Department, Hospital Británico de Buenos Aires, Perdriel 74, 1280, CABA, Argentina

    Joaquin Fernandez-Alberti, Lautaro Mata, Facundo Orrego & Diego Bogetti

  2. Abdominal Wall Surgery Department, Hospital Británico de Buenos Aires, Perdriel 74, 1280, CABA, Argentina

    Pablo Medina & Eduardo Agustin Porto

  3. Director of General Surgery Department, Hospital Británico de Buenos Aires, Perdriel 74, 1280, CABA, Argentina

    Daniel Enrique Pirchi

Authors
  1. Joaquin Fernandez-Alberti
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  2. Lautaro Mata
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  3. Facundo Orrego
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  4. Pablo Medina
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  5. Diego Bogetti
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  6. Eduardo Agustin Porto
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by JFA, LM, FO, PM, DB, EAP and DEP. The first draft of the manuscript was written by JFA and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Joaquin Fernandez-Alberti.

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Disclosures

Drs. Joaquin Fernandez-Alberti, Lautaro Mata, Facundo Orrego, Pablo Medina, Diego Bogetti, Eduardo Agustin Porto and Daniel Enrique Pirchi have no conflicts of interest or financial ties to disclose. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Ethical approval

Ethical approval was waived by the local Ethics Committee of the British Hospital of Buenos Aires in view of the retrospective nature of the study and all the procedures being performed were part of the routine care.

Consent to participate

Due to the retrospective nature of the study, the Ethics Committee waived the requirement for written informed consent; however, all patients signed the surgical consent form.

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Fernandez-Alberti, J., Mata, L., Orrego, F. et al. Laparoscopic inguinal hernia repair: impact of surgical time in the learning curve. Surg Endosc 37, 2826–2832 (2023). https://doi.org/10.1007/s00464-022-09807-5

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  • DOI: https://doi.org/10.1007/s00464-022-09807-5

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