Masaki Wakasugi, Yujiro Nakahara, Masaki Hirota, Takashi Matsumoto, Hiroyoshi Takemoto, Ko Takachi, Kiyonori Nishioka, Satoshi Oshima. Department of Surgery, Kinki Central Hospital
The aim of this study was to clarify the learning curve for single-incision laparoscopic surgery for totally extraperitoneal repair (SILS-TEP).
Patients and Methods:
A retrospective analysis of 50 consecutive patients with unilateral inguinal hernia undergoing elective SILS-TEP by a single surgeon between July 2016 and September 2017 was performed.
Patients with a history of radical prostatectomy, young patients with a small indirect inguinal hernia, and patients for whom general anesthesia was contraindicated were excluded from this study.
A single, 2.5-cm, intraumbilical incision was made, and blunt dissection was performed between the muscle and the posterior sheath to create a preperitoneal space. After placing a Lap-Protector Mini in this space, three 5-mm trocars were inserted through a single-port access device. The preperitoneal space was dissected gradually, using straight laparoscopic instruments without a dissection balloon. Mesh was placed in this preperitoneal space, covering the inguinal floor, and was fixed with absorbable tacks. After completion of the operation, the preperitoneal space was carefully deflated to avoid displacing the mesh. The anterior rectus sheath and skin were closed with an absorbable suture.
The first 25 cases were categorized into the learning period group, and the later cases were categorized into the experienced period group. There were no significant differences between the two groups in age, sex, and body mass index.
Moving average curve
The mean operating time for each set of 10 cases decreased continuously. The operating time gradually stabilized after 20 cases and showed a decrease after 30 cases.
Comparison of operative outcomes
The median operative time for a unilateral hernia in the learning period group and the experienced period group was 102 min and 75 min, respectively (p<0.05). There were no conversions to a different operative procedure in either group. The median duration of postoperative hospital stay was 1 day in both groups. Peritoneal injury occurred in 32% (8/25) of the learning period group and 24% (6/25) of the experienced period group (p=0.8).
Postoperative complications, including seroma, wound infection, and mesh infection, were seen in 24% (6/25) of patients in the learning period group and 4% (1/25) of patients in the experienced period group (p=0.1). These complications were managed conservatively. No other major complications or hernia recurrence were noted.
The number of patients needed to become proficient in SILS-TEP might be approximately 25 cases.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86293
Program Number: P025
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster