Jacob A Greenberg, MD, EdM, Sally A Jolles, MA, Sarah Sullivan, PhD, Sudha P Quamme, MD, Caprice C Greenberg, MD, MPH, Carla M Pugh, MD, PhD. University of Wisconsin
Introduction: Laparoscopic inguinal hernia repair has been shown to have some significant benefits compared to open inguinal hernia repair, yet remains underutilized in the United States. The traditional model of utilizing short hands-on and cognitive courses to enhance adoption of new techniques fails to lead to significant levels of implementation into practice for most surgeons. We hypothesized that a more comprehensive program would help facilitate adoption of totally extraperitoneal laparoscopic inguinal hernia repair(TEP) for practicing surgeons.
Methods: A team of experts in simulation, coaching, and TEP created a comprehensive training program utilizing simulation, hands-on training, preceptoring, and surgical coaching via video review to facilitate adoption of TEP. Three surgeons who routinely performed open inguinal hernia repair with greater than 50 cases annually were recruited to participate in the program. Coaches were selected based on their procedural expertise and underwent formal training in surgical coaching. Participants were required to evaluate all aspects of the educational program and were surveyed out to one year following completion of the program to assess for continued adoption of TEP into their practice.
Results: All three participants successfully completed the first 3 steps of the 7 Step program. Only two completed the full course. The first participant was able to complete all steps in 7 months, while the second participant completed all steps in 5 months. The third participant dropped out of the program due to time constraints and low case volume. All program components, including Simulation (4.7/5), GlovesOn training (5/5), and Preceptored Cases (5/5) scored highly on surgeon satisfaction. At one year, both participants were using TEP for “most of their cases” and were confident in their ability to perform the procedure. Participant one reported that they most valued their precepted cases with their coach and their live coaching sessions. The second participant reported that the precepted cases with their coach was the most important step in furthering their TEP education. The total cost of the program including all travel, personal coaching and simulation was $8,638.60 per participant.
Discussion: Our comprehensive educational program led to full and sustained adoption of TEP for those who completed the course. Time constraints, travel costs and case volume are major considerations however, the benefits appear to outweigh these limitations.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80042
Program Number: S111
Presentation Session: Hernias: Inguinal and Robotics
Presentation Type: Podium