Optimal teaching environment for laparoscopic ventral herniorrhaphy

The introduction of laparoscopic techniques after residency training has created a new paradigm dependent on laparoscopic workshops. This study tested the benefit of an animate course and evaluated the role of proctoring in learning to perform laparoscopic ventral hernia repair (LVHR). Surgeons who had taken a 1-day LVHR course (n = 59) were polled to determine previous experience with laparoscopic procedures and experience with LVHR after the course. Forty-eight (81%) surgeons completing the course responded. Thirty-two (67%) surgeons had performed 179 LVHRS (mean 5.6) since the course. There were no statistically significant differences between the groups performing and not performing LVHR regarding academic/private practice (P=0.8) or opportunities to perform a ventral herniorrhaphy (P = 0.6). Fifteen (31%) surgeons were precepted in their hospital operating room by the lead author. Thirteen (87%) of precepted surgeons had performed a LVHR compared with 19 (58%) of the 33 surgeons taking the course without a precepted intervention (P = 0.05). Surgeons with experience performing laparoscopic inguinal hernia repair, Nissen fundoplication, and common bile duct exploration were more likely to perform LVHR (P=0.0001). Surgeons performing only laparoscopic cholecystectomy tended to be less likely to perform LVHR, nearing statistical significance (P=0.08). Surgeons with prior advanced laparoscopic surgery experience are thus more likely to perform LVHR after participating in a 1-day course. Surgeons precepted in their hospital operating room were also more likely to perform LVHR. Participation in an animate laboratory and a precepted experience can impact the future performance of advanced laparoscopic surgery.