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Learning Curves for Laparoscopic Repair of Inguinal Hernia and Communicating Hydrocele in Children
Catarina Barroso1,2,3, Péter Etlinger1,2,3, Ana Luísa Alves2,3
1Department of Pediatric Surgery, Hospital Braga, Braga, Portugal.
Insights
Surgeons need 35 laparoscopic cases to master percutaneous internal ring suturing (PIRS) for hernia repair, reducing complications. Increased male patient percentages indicate growing team confidence in the PIRS technique.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Surgical Education
Background:
- Implementation of the percutaneous internal ring suturing (PIRS) technique requires understanding surgeon and departmental learning curves.
- Assessing learning curves is crucial for safe and effective adoption of new surgical methods.
Purpose of the Study:
- To analyze surgeon and department learning curves during the implementation of the PIRS technique.
- To identify the number of cases required to reach benchmark outcomes for PIRS compared to open repair.
Main Methods:
- A cohort of 607 children undergoing inguinal hernia or communicating hydrocele repair were included.
- Surgeons performed either open or PIRS repair after mentorship.
- Learning curves were assessed by analyzing perioperative complications, conversion rates, ipsilateral recurrence, postoperative complications, and metachronous hernia rates.
Main Results:
- Perioperative complications, conversion, and ipsilateral recurrence rates decreased with experience, reaching open repair benchmarks after approximately 35 PIRS cases per surgeon.
- Postoperative complications were independent of the learning curve.
- Metachronous hernia rates were lower in PIRS patients, and the increasing percentage of males operated by PIRS indicated growing team confidence.
Conclusions:
- Thirty-five laparoscopic cases per surgeon are necessary to achieve benchmark outcomes for perioperative complications, conversion, and ipsilateral recurrence using PIRS.
- The proportion of male patients undergoing PIRS reflects the team's increasing confidence in the technique.
Introduction:
We analyzed the department and surgeon learning curves during implementation of the percutaneous internal ring suturing (PIRS) technique in our department.
Methods:
Children proposed for inguinal hernia or communicating hydrocele repair were included (n = 607). After mentorship, all surgeons were free to propose open or PIRS repair. From gathered data, we assessed department and surgeon learning curves through cumulative experience focusing in perioperative complications, conversion, ipsilateral recurrence, postoperative complications, and metachronous hernia, with benchmarks defined by open repair.
Results:
Department-centered analysis revealed that perioperative complications, conversion, and ipsilateral recurrence rates were higher in the beginning, reaching the benchmarks when each surgeon performed, at least, 35 laparoscopic repairs. Postoperative complications and metachronous hernia rates were independent from learning curves, with the metachronous hernia rate being significantly lower in PIRS patients. During the program, the percentage of males in those operated by PIRS progressively increased reaching the percentage of males, in our sample, when department operated over 230 cases.
Conclusion:
Thirty-five laparoscopic cases per surgeon are required for perioperative complications, conversion, and ipsilateral recurrence reach the benchmark. The gap between the percentage of males, in those operated by PIRS and in those proposed for surgery, monitors the confidence of the team in the program.
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