單孔腹腔鏡疝氣修補手術的學習經驗曲線

許靖承 陳鴻毅

基隆長庚醫院 外科部 泌尿科

Learning curve for Laparoscopic endoscopic single site total extra-peritoneum inguinal hernia repair

Ching-Cheng Hsu, Hung-Yi Chen

Divisions of Urology, Department of Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan

Purpose:

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 accus tomed and the limited working space. The aim of this study was to clarify the learning curve for LESS-TEP.

Materials and Methods:

A retrospective analysis of 49 consecutive patients with unilateral inguinal hernia was performed. All patients underwent elective LESS-TEP performed by a single learning surgeon between July 2019 and Dec 2022 at Keelung Chang-Gung memorial Hospital. Operative time was assessed by cumulative sum (CUSUM) analysis and moving average to evaluate the learning curve.

Results:

The operative time decreased gradually after 23 cases The first 23 cases were categorized as the learning period group, and the remaining 25 cases were categorized as the experienced period group. The median operative time was 128 and 87 min in the learning period and the experienced period, respectively (P < 0.05). There were no significant differences in 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.

Conclusion:

The learning curve for LESS-TEP is approximately 23 cases. LESS-TEP can be performed safely by a learning surgeon with a teaching assistant.