Christian Massier, William Walsh, DO, Jillian Sinopoli, DO. Cleveland Clinic
Background: Laparoscopic inguinal hernia extraperitoneal repair is a difficult task to learn. The number of cases required to become proficient during surgical training is not known. This study aimed to assess the reliability of a procedure specific scoring systems, to compare resident performance along training years and construct personalized feedback of operative skill to trainee.
Methods: Resident operative performance was recorded prospectively and analyzed in relationship to their prior experience in laparoscopic hernia repair and other complex laparoscopic procedures as well as anatomical difficulty of the patient. Performance (amount of attending assistance) and duration was recorded using procedure-specific checklist (access, cord dissection, hernia sac reduction, mesh placement).
Results: The study included 12 residents in a general surgery training program and 100 procedures performed over 18 months. A strong positive correlation was found between prior resident experience and each of the surgical steps. Mesh placement scores are stronger correlated with experience and difficulty than other procedural steps. Operative times are inverse correlated with experience. Performance correlates negatively with anatomical difficulty.
Conclusion: Progress is quick only for port placement. Proficiency can be achieved after 10 cases for easy hernias but may take more then 30 cases for difficult hernias. Learning curve mirrors number of prior complex laparoscopic cases. Individual resident performance over time can be analyzed and personalized feedback constructed to guide further training needs.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94301
Program Number: P389
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster