Laparoscopic totally extraperitoneal hernia repair performed by surgical trainees: overcoming the learning curve. Issue 10 (10th August 2021)

• Record Type: Journal Article
• Authors: Hannan, Enda; Duggan, William; Harding, Tim; Brosnan, Conor; Maguire, Donal; Stafford, Anthony T
• Is Part Of: ANZ journal of surgery. Volume 91:Issue 10(2021)
• Page Start: 2047
• Page End: 2053
• Publication Date: 2021-08-10
• Subjects: inguinal hernia -- laparoscopic -- surgical education -- surgical training -- totally extraperitoneal; Surgery -- Periodicals; 617.005
• DOI: 10.1111/ans.17114
• Languages: English
• ISSNs: 1445-1433

Abstract

Abstract: Background: Surgical trainees struggle to obtain experience in laparoscopic inguinal hernia repair (LIHR) due to a perceived steep learning curve. The purpose of this study was to compare outcomes in totally extraperitoneal (TEP) repair performed by surgical consultants and trainees under supervision as part of a standardised training regimen to assess the safety of residency training in this technique. Methods: A retrospective review of patients managed by TEP repair by either a consultant or a supervised trainee was performed. Demographic, perioperative and postoperative data were collected and compared. All trainees underwent a standardised approach to teaching TEP repair. Results: Trainees performed 133 procedures and consultants performed 121 procedures. Estimated blood loss was minimal in both cohorts. A significant difference was noted in mean operating time between consultants and trainees (33 vs. 50 min). However, it was also observed that the trainee mean operating time reduced significantly with experience (from 61 to 42 min). No statistically significant difference was demonstrated in postoperative complications, recurrence rate or length of stay. All trainees achieved the ability to complete a laparoscopic TEP repair under unscrubbed consultant supervision during a 1‐year placement. Conclusion: With senior supervision and in the presence of a structured training regimen, trainees can safely and effectively perform LIHR, progressing to performing the procedure under unscrubbed consultant supervision. This is valuable information that can serve to inform the structure and direction of surgical training programmes as the ability to offer LIHR is increasingly becoming an expectation of consultant surgeons. Abstract : Our study provides valuable evidence that, with appropriate senior supervision and in the presence of a structured training regimen, trainees can safely and effectively perform laparoscopic totally extraperitoneal repair, progressing to a point where they can perform the procedure under unscrubbed consultant supervision. This is valuable information that can serve to inform the structure and direction of surgical training programmes as the ability to offer laparoscopic inguinal hernia repair is increasingly becoming an expectation of consultant surgeons.