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Outcome and learning curve for laparoscopic intra-corporeal inguinal hernia repair in children
Adrian Chi Heng Fung1, Ivy Hau Yee Chan2,3, Kenneth Kak Yuen Wong1
1Division of Paediatric Surgery, Department of Surgery, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, People's Republic of China.
Insights
Surgical trainees master laparoscopic inguinal hernia repair after approximately 18 procedures, demonstrating a safe and transferable technique for pediatric patients. This minimally invasive surgery offers valuable skill acquisition for new surgeons.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Surgical Education
Background:
- Laparoscopic inguinal hernia repair is a common pediatric surgical procedure.
- Limited research exists on the learning curve for this technique in children.
- This study evaluates clinical outcomes and the learning curve for pediatric laparoscopic intra-corporeal inguinal hernia repair.
Purpose of the Study:
- To assess the clinical outcomes of laparoscopic intra-corporeal inguinal hernia repair in children.
- To determine the learning curve for surgical trainees performing this procedure.
- To evaluate the safety and transferability of the technique for pediatric patients.
Main Methods:
- Retrospective analysis of 719 pediatric patients (2010-2019).
- Evaluation of clinical outcomes and operative times.
- CUSUM analysis to assess the learning curve achievement by trainees.
Main Results:
- A total of 719 patients (1051 sides) underwent the procedure.
- Overall ipsilateral recurrence rate was 1.8% with no other detected complications.
- CUSUM analysis indicated 3 training phases, with trainees reaching senior surgeon performance levels after 18 procedures.
Conclusions:
- Surgical trainees require approximately 18 procedures to reach the learning curve plateau for operative time.
- Laparoscopic intra-corporeal inguinal hernia repair is a safe and transferable technique for pediatric patients.
- The procedure facilitates skill acquisition in minimally invasive surgery for trainees with adequate supervision.
Background:
Laparoscopic inguinal hernia repair is one of the procedures most commonly performed by paediatric surgeons. Current research on the learning curve for laparoscopic hernia repair in children is scarce. This study aims to evaluate the clinical outcome and learning curve of laparoscopic intra-corporeal inguinal hernia repair in children.
Methods:
A retrospective single-centre analysis of all paediatric patients who underwent laparoscopic intra-corporeal inguinal hernia repair between 2010 and 2019 was performed. The clinical outcomes were analysed. The data on the achievement of the learning curve by surgical trainees were evaluated with the CUSUM technique, focusing on operative time.
Results:
There were 719 patients with laparoscopic intra-corporeal inguinal hernia repair (comprising 1051 sides) performed during the study period. The overall ipsilateral recurrence rate was 1.8% without other complications detected. CUSUM analysis showed that there were 3 phases of training, for which the trainees underwent initial learning phase (Phase 1) for the first 7 cases. After mastering of the skills and extrapolating the skills to male patients with smaller body size (Phase 2), they then achieved performance comparable to that of the senior surgeons after 18 procedures (Phase 3).
Conclusions:
18 procedures seem to be the number required to reach the learning curve plateau in terms of operative time by surgical trainees. The clinical outcomes show that laparoscopic intra-corporeal inguinal hernia repair is a safe and transferrable technique, even in the hands of trainees, with adequate supervision and careful case selection. It also provides skill acquisition for minimally invasive surgery.
