Understanding How Experts Do It: A Conceptual Framework for the Open Transversus Abdominis Release Procedure

Area of Science:

• Surgical technique analysis
• Medical education and training
• Hernia repair outcomes

Background:

• Transversus abdominis release (TAR) is a complex surgical technique.
• Objective evaluation and standardization of TAR are challenging.
• This study addresses the need for a structured approach to TAR training.

Purpose of the Study:

• To develop a framework for training and evaluating the transversus abdominis release (TAR) procedure.
• To identify and define essential cognitive behaviors and decision-making skills for optimal TAR performance.
• To establish objective criteria for assessing surgeon proficiency in TAR.

Main Methods:

• Qualitative study employing hierarchical and cognitive task analyses.
• Semistructured interviews with experienced hernia surgeons.
• Thematic analysis of transcribed interview data, field observations, and literature review.

Main Results:

• Identified 80 subtasks, 86 potential errors, 36 cognitive behaviors, and 17 decision points within the TAR procedure.
• Categorized findings into 10 procedural steps and 9 fundamental principles.
• Synthesized a conceptual framework for TAR performance based on expert insights.

Conclusions:

• This research presents the first comprehensive definition of critical tasks, decisions, and cognitive behaviors for successful TAR.
• The developed framework can guide the training and objective evaluation of surgeons performing TAR.
• This study contributes to improving the safety and effectiveness of hernia repair surgery.