Is there an end of the “learning curve” of endoscopic totally extraperitoneal (TEP) hernia repair?
Background An important challenge of totally extraperitoneal (TEP) hernia repair is the learning curve. The European guidelines suggest that the learning curve ranges between 50 and 100 procedures, with the first 30–50 being critical. Others suggest that optimal outcomes are achieved after 200 or mo...
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| Veröffentlicht in: | Surgical endoscopy 2013-03, Vol.27 (3), p.789-794 |
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| creator | Schouten, N. Simmermacher, R. K. J. van Dalen, T. Smakman, N. Clevers, G. J. Davids, P. H. P. Verleisdonk, E. J. M. M. Burgmans, J. P. J. |
| description | Background
An important challenge of totally extraperitoneal (TEP) hernia repair is the learning curve. The European guidelines suggest that the learning curve ranges between 50 and 100 procedures, with the first 30–50 being critical. Others suggest that optimal outcomes are achieved after 200 or more TEP procedures.
Methods
All TEP repairs performed between 2005 and 2009 were included in this study. The effect of (surgeon) expertise on perioperative complications, conversion to open anterior repair, and operative time was assessed to evaluate the extent of the learning curve of TEP repair.
Results
Intraoperative complications occurred in |
| doi_str_mv | 10.1007/s00464-012-2512-0 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1288312722</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1288312722</sourcerecordid><originalsourceid>FETCH-LOGICAL-c372t-d5ef94006906016fedc9932185f3a766088f94f754ca4ac205efdd39de2b7b093</originalsourceid><addsrcrecordid>eNp1kU1OHDEQhS0UlBkgB2ATWcoGFg3ln_7xKooQJEgjwQLWlsddPelRj92xu1HYcRC4HCfBrQGEImVjq_S-euXyI-SQwQkDKE8jgCxkBoxnPE8H7JA5kyJVnFWfyByUgIyXSs7IXoxrSLhi-Wcy4wJyLpWck-Yy0uE3BqTGUXQ19c1U0-eHxw5NcK1bUTuGO3x-eJq0hPhofd9aOvjBdN09xb9DMD2GdvAOTUePbs6vj2nydK2hAXvThu8HZLcxXcQvr_c-ub04vzn7lS2ufl6e_VhkVpR8yOocGyUBCgUFsKLB2iol0jJ5I0xZFFBVSW_KXFojjeWQ-LoWqka-LJdp3X1ytPXtg_8zYhz0po0Wu8449GPUjFeVYLzkPKHf_kHXfgwuvW6iSlEVBWOJYlvKBh9jwEb3od2YcK8Z6CkEvQ1BpxD0FIKG1PP11XlcbrB-73j79QTwLRCT5FYYPoz-r-sL_UeSPg</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1287386611</pqid></control><display><type>article</type><title>Is there an end of the “learning curve” of endoscopic totally extraperitoneal (TEP) hernia repair?</title><source>MEDLINE</source><source>SpringerNature Journals</source><creator>Schouten, N. ; Simmermacher, R. K. J. ; van Dalen, T. ; Smakman, N. ; Clevers, G. J. ; Davids, P. H. P. ; Verleisdonk, E. J. M. M. ; Burgmans, J. P. J.</creator><creatorcontrib>Schouten, N. ; Simmermacher, R. K. J. ; van Dalen, T. ; Smakman, N. ; Clevers, G. J. ; Davids, P. H. P. ; Verleisdonk, E. J. M. M. ; Burgmans, J. P. J.</creatorcontrib><description>Background
An important challenge of totally extraperitoneal (TEP) hernia repair is the learning curve. The European guidelines suggest that the learning curve ranges between 50 and 100 procedures, with the first 30–50 being critical. Others suggest that optimal outcomes are achieved after 200 or more TEP procedures.
Methods
All TEP repairs performed between 2005 and 2009 were included in this study. The effect of (surgeon) expertise on perioperative complications, conversion to open anterior repair, and operative time was assessed to evaluate the extent of the learning curve of TEP repair.
Results
Intraoperative complications occurred in <1 % of the 3,432 patients and postoperative complications were observed in 243 (7 %) patients. With a median follow-up of 2 years after TEP, 19 patients (0.55 %) had a recurrence. During the study period, at the end of which all four surgeons had treated 900–1,000 patients, intraoperative complications and recurrences did not decline. On the other hand, the median operative time decreased from 30 to 20 min (
p
<
0.001). The conversion rate (1.6–0.2 %,
p
=
0.018) and postoperative complication rate (11.6–4.2 %,
p
< 0.001) also declined. The decline was observed for all four surgeons, irrespective of their initial expertise with TEP. The largest decrease in the conversion rate was seen after at least 250 TEP procedures; the postoperative complication rate and operative time showed a linear and significant decline throughout the study period. A more or less “steady state” was observed after approximately 450 procedures per surgeon.
Conclusions
Even after more than 400 individually performed TEP procedures, there is progress in reducing the conversion rate, the incidence of short-term postoperative complications, and operative time, indicating a rather long learning curve.</description><identifier>ISSN: 0930-2794</identifier><identifier>EISSN: 1432-2218</identifier><identifier>DOI: 10.1007/s00464-012-2512-0</identifier><identifier>PMID: 23052494</identifier><language>eng</language><publisher>New York: Springer-Verlag</publisher><subject>Abdominal Surgery ; Clinical Competence - standards ; Conversion to Open Surgery - statistics & numerical data ; Endoscopy ; Endoscopy - education ; Female ; Gastroenterology ; General anesthesia ; General Surgery - standards ; Gynecology ; Hepatology ; Hernia, Inguinal - surgery ; Hernias ; Herniorrhaphy - education ; Herniorrhaphy - methods ; Hospitals ; Humans ; Intraoperative Complications - etiology ; Learning Curve ; Learning curves ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Operative Time ; Outpatient care facilities ; Patients ; Postoperative Complications - etiology ; Proctology ; Recovery of Function ; Recurrence ; Surgeons ; Surgery ; Treatment Outcome</subject><ispartof>Surgical endoscopy, 2013-03, Vol.27 (3), p.789-794</ispartof><rights>Springer Science+Business Media, LLC 2012</rights><rights>Springer Science+Business Media New York 2013</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c372t-d5ef94006906016fedc9932185f3a766088f94f754ca4ac205efdd39de2b7b093</citedby><cites>FETCH-LOGICAL-c372t-d5ef94006906016fedc9932185f3a766088f94f754ca4ac205efdd39de2b7b093</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00464-012-2512-0$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00464-012-2512-0$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>315,782,786,27933,27934,41497,42566,51328</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23052494$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Schouten, N.</creatorcontrib><creatorcontrib>Simmermacher, R. K. J.</creatorcontrib><creatorcontrib>van Dalen, T.</creatorcontrib><creatorcontrib>Smakman, N.</creatorcontrib><creatorcontrib>Clevers, G. J.</creatorcontrib><creatorcontrib>Davids, P. H. P.</creatorcontrib><creatorcontrib>Verleisdonk, E. J. M. M.</creatorcontrib><creatorcontrib>Burgmans, J. P. J.</creatorcontrib><title>Is there an end of the “learning curve” of endoscopic totally extraperitoneal (TEP) hernia repair?</title><title>Surgical endoscopy</title><addtitle>Surg Endosc</addtitle><addtitle>Surg Endosc</addtitle><description>Background
An important challenge of totally extraperitoneal (TEP) hernia repair is the learning curve. The European guidelines suggest that the learning curve ranges between 50 and 100 procedures, with the first 30–50 being critical. Others suggest that optimal outcomes are achieved after 200 or more TEP procedures.
Methods
All TEP repairs performed between 2005 and 2009 were included in this study. The effect of (surgeon) expertise on perioperative complications, conversion to open anterior repair, and operative time was assessed to evaluate the extent of the learning curve of TEP repair.
Results
Intraoperative complications occurred in <1 % of the 3,432 patients and postoperative complications were observed in 243 (7 %) patients. With a median follow-up of 2 years after TEP, 19 patients (0.55 %) had a recurrence. During the study period, at the end of which all four surgeons had treated 900–1,000 patients, intraoperative complications and recurrences did not decline. On the other hand, the median operative time decreased from 30 to 20 min (
p
<
0.001). The conversion rate (1.6–0.2 %,
p
=
0.018) and postoperative complication rate (11.6–4.2 %,
p
< 0.001) also declined. The decline was observed for all four surgeons, irrespective of their initial expertise with TEP. The largest decrease in the conversion rate was seen after at least 250 TEP procedures; the postoperative complication rate and operative time showed a linear and significant decline throughout the study period. A more or less “steady state” was observed after approximately 450 procedures per surgeon.
Conclusions
Even after more than 400 individually performed TEP procedures, there is progress in reducing the conversion rate, the incidence of short-term postoperative complications, and operative time, indicating a rather long learning curve.</description><subject>Abdominal Surgery</subject><subject>Clinical Competence - standards</subject><subject>Conversion to Open Surgery - statistics & numerical data</subject><subject>Endoscopy</subject><subject>Endoscopy - education</subject><subject>Female</subject><subject>Gastroenterology</subject><subject>General anesthesia</subject><subject>General Surgery - standards</subject><subject>Gynecology</subject><subject>Hepatology</subject><subject>Hernia, Inguinal - surgery</subject><subject>Hernias</subject><subject>Herniorrhaphy - education</subject><subject>Herniorrhaphy - methods</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Intraoperative Complications - etiology</subject><subject>Learning Curve</subject><subject>Learning curves</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Operative Time</subject><subject>Outpatient care facilities</subject><subject>Patients</subject><subject>Postoperative Complications - etiology</subject><subject>Proctology</subject><subject>Recovery of Function</subject><subject>Recurrence</subject><subject>Surgeons</subject><subject>Surgery</subject><subject>Treatment Outcome</subject><issn>0930-2794</issn><issn>1432-2218</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp1kU1OHDEQhS0UlBkgB2ATWcoGFg3ln_7xKooQJEgjwQLWlsddPelRj92xu1HYcRC4HCfBrQGEImVjq_S-euXyI-SQwQkDKE8jgCxkBoxnPE8H7JA5kyJVnFWfyByUgIyXSs7IXoxrSLhi-Wcy4wJyLpWck-Yy0uE3BqTGUXQ19c1U0-eHxw5NcK1bUTuGO3x-eJq0hPhofd9aOvjBdN09xb9DMD2GdvAOTUePbs6vj2nydK2hAXvThu8HZLcxXcQvr_c-ub04vzn7lS2ufl6e_VhkVpR8yOocGyUBCgUFsKLB2iol0jJ5I0xZFFBVSW_KXFojjeWQ-LoWqka-LJdp3X1ytPXtg_8zYhz0po0Wu8449GPUjFeVYLzkPKHf_kHXfgwuvW6iSlEVBWOJYlvKBh9jwEb3od2YcK8Z6CkEvQ1BpxD0FIKG1PP11XlcbrB-73j79QTwLRCT5FYYPoz-r-sL_UeSPg</recordid><startdate>20130301</startdate><enddate>20130301</enddate><creator>Schouten, N.</creator><creator>Simmermacher, R. K. J.</creator><creator>van Dalen, T.</creator><creator>Smakman, N.</creator><creator>Clevers, G. J.</creator><creator>Davids, P. H. P.</creator><creator>Verleisdonk, E. J. M. M.</creator><creator>Burgmans, J. P. J.</creator><general>Springer-Verlag</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20130301</creationdate><title>Is there an end of the “learning curve” of endoscopic totally extraperitoneal (TEP) hernia repair?</title><author>Schouten, N. ; Simmermacher, R. K. J. ; van Dalen, T. ; Smakman, N. ; Clevers, G. J. ; Davids, P. H. P. ; Verleisdonk, E. J. M. M. ; Burgmans, J. P. J.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c372t-d5ef94006906016fedc9932185f3a766088f94f754ca4ac205efdd39de2b7b093</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Abdominal Surgery</topic><topic>Clinical Competence - standards</topic><topic>Conversion to Open Surgery - statistics & numerical data</topic><topic>Endoscopy</topic><topic>Endoscopy - education</topic><topic>Female</topic><topic>Gastroenterology</topic><topic>General anesthesia</topic><topic>General Surgery - standards</topic><topic>Gynecology</topic><topic>Hepatology</topic><topic>Hernia, Inguinal - surgery</topic><topic>Hernias</topic><topic>Herniorrhaphy - education</topic><topic>Herniorrhaphy - methods</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Intraoperative Complications - etiology</topic><topic>Learning Curve</topic><topic>Learning curves</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Operative Time</topic><topic>Outpatient care facilities</topic><topic>Patients</topic><topic>Postoperative Complications - etiology</topic><topic>Proctology</topic><topic>Recovery of Function</topic><topic>Recurrence</topic><topic>Surgeons</topic><topic>Surgery</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Schouten, N.</creatorcontrib><creatorcontrib>Simmermacher, R. K. J.</creatorcontrib><creatorcontrib>van Dalen, T.</creatorcontrib><creatorcontrib>Smakman, N.</creatorcontrib><creatorcontrib>Clevers, G. J.</creatorcontrib><creatorcontrib>Davids, P. H. P.</creatorcontrib><creatorcontrib>Verleisdonk, E. J. M. M.</creatorcontrib><creatorcontrib>Burgmans, J. P. J.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Surgical endoscopy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Schouten, N.</au><au>Simmermacher, R. K. J.</au><au>van Dalen, T.</au><au>Smakman, N.</au><au>Clevers, G. J.</au><au>Davids, P. H. P.</au><au>Verleisdonk, E. J. M. M.</au><au>Burgmans, J. P. J.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Is there an end of the “learning curve” of endoscopic totally extraperitoneal (TEP) hernia repair?</atitle><jtitle>Surgical endoscopy</jtitle><stitle>Surg Endosc</stitle><addtitle>Surg Endosc</addtitle><date>2013-03-01</date><risdate>2013</risdate><volume>27</volume><issue>3</issue><spage>789</spage><epage>794</epage><pages>789-794</pages><issn>0930-2794</issn><eissn>1432-2218</eissn><abstract>Background
An important challenge of totally extraperitoneal (TEP) hernia repair is the learning curve. The European guidelines suggest that the learning curve ranges between 50 and 100 procedures, with the first 30–50 being critical. Others suggest that optimal outcomes are achieved after 200 or more TEP procedures.
Methods
All TEP repairs performed between 2005 and 2009 were included in this study. The effect of (surgeon) expertise on perioperative complications, conversion to open anterior repair, and operative time was assessed to evaluate the extent of the learning curve of TEP repair.
Results
Intraoperative complications occurred in <1 % of the 3,432 patients and postoperative complications were observed in 243 (7 %) patients. With a median follow-up of 2 years after TEP, 19 patients (0.55 %) had a recurrence. During the study period, at the end of which all four surgeons had treated 900–1,000 patients, intraoperative complications and recurrences did not decline. On the other hand, the median operative time decreased from 30 to 20 min (
p
<
0.001). The conversion rate (1.6–0.2 %,
p
=
0.018) and postoperative complication rate (11.6–4.2 %,
p
< 0.001) also declined. The decline was observed for all four surgeons, irrespective of their initial expertise with TEP. The largest decrease in the conversion rate was seen after at least 250 TEP procedures; the postoperative complication rate and operative time showed a linear and significant decline throughout the study period. A more or less “steady state” was observed after approximately 450 procedures per surgeon.
Conclusions
Even after more than 400 individually performed TEP procedures, there is progress in reducing the conversion rate, the incidence of short-term postoperative complications, and operative time, indicating a rather long learning curve.</abstract><cop>New York</cop><pub>Springer-Verlag</pub><pmid>23052494</pmid><doi>10.1007/s00464-012-2512-0</doi><tpages>6</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0930-2794 |
| ispartof | Surgical endoscopy, 2013-03, Vol.27 (3), p.789-794 |
| issn | 0930-2794 1432-2218 |
| language | eng |
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| source | MEDLINE; SpringerNature Journals |
| subjects | Abdominal Surgery Clinical Competence - standards Conversion to Open Surgery - statistics & numerical data Endoscopy Endoscopy - education Female Gastroenterology General anesthesia General Surgery - standards Gynecology Hepatology Hernia, Inguinal - surgery Hernias Herniorrhaphy - education Herniorrhaphy - methods Hospitals Humans Intraoperative Complications - etiology Learning Curve Learning curves Male Medicine Medicine & Public Health Middle Aged Operative Time Outpatient care facilities Patients Postoperative Complications - etiology Proctology Recovery of Function Recurrence Surgeons Surgery Treatment Outcome |
| title | Is there an end of the “learning curve” of endoscopic totally extraperitoneal (TEP) hernia repair? |
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