Ray Meng See, Calvin Enpeng Chen, Theresa Harbig, Luca T Frericks, Jens Rolinger, Markus D Enderle, Davide Lomanto, Sujith Indeewara Wijerathne
{"title":"Energy profile of laparoscopic TEP bilateral inguinal hernia repairs.","authors":"Ray Meng See, Calvin Enpeng Chen, Theresa Harbig, Luca T Frericks, Jens Rolinger, Markus D Enderle, Davide Lomanto, Sujith Indeewara Wijerathne","doi":"10.1007/s10029-026-03878-2","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Laparoscopic totally extraperitoneal (TEP) inguinal hernia repair is effective but technically demanding, with a long learning curve conventionally characterized using operative time. Electrosurgical generator data is a routinely produced yet underexploited signal that may yield an objective, phase-specific descriptor of intraoperative performance. We aimed to characterize the intraoperative electrosurgical energy profile of bilateral TEP repairs performed by an experienced surgeon and to assess its consistency across cases, as a feasible preliminary step towards future objective referencing of energy profile usage in hernia surgery.</p><p><strong>Methods: </strong>Eight adult patients undergoing elective bilateral TEP repair for primary, non-complex inguinal hernia between July 2023 and March 2024 were included in this prospective single-center observational study. Intraoperative electrosurgical data were captured by a data logger connected to the electrosurgical unit and synchronized with laparoscopic video. All procedures were performed by an experienced and specialized surgeon. The procedure was divided into nine phases; energy emitted per minute and the duty cycle per phase were analyzed, and inter-case consistency of the duty-cycle profile was quantified using Pearson correlation.</p><p><strong>Results: </strong>A case-specific digital energy profile combining monopolar and bipolar use was mapped for each patient. Intervention duration ranged from 41 to 85 min (median 56.5), total activation duration from 2.09 to 5.45 min (median 3.77), and total emitted energy from 1670 to 7224 J (median 5043.5). Energy use was comparable between hernias of maximum EHS grade 1 and 2, whereas hernias of maximum EHS grade 3 showed more than 50% higher energy use. The duty cycle was highest during the main dissection phases and decreased toward parietalisation and this was consistent across the cases analysed. No postoperative complications occurred, and all patients were discharged the same day.</p><p><strong>Conclusion: </strong>The intraoperative electrosurgical energy profile of bilateral TEP repairs by an experienced surgeon is reproducible across cases and resolves into a phase-specific pattern that mirrors the underlying surgical anatomy. This exploratory analysis provides a foundation for subsequent comparative studies in which trainees could objectively compare their electrosurgical behavior against an experienced reference, complementing existing learning aids in TEP and other phase-structured procedures.</p>","PeriodicalId":13168,"journal":{"name":"Hernia","volume":"30 1","pages":""},"PeriodicalIF":2.7000,"publicationDate":"2026-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Hernia","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s10029-026-03878-2","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"SURGERY","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Laparoscopic totally extraperitoneal (TEP) inguinal hernia repair is effective but technically demanding, with a long learning curve conventionally characterized using operative time. Electrosurgical generator data is a routinely produced yet underexploited signal that may yield an objective, phase-specific descriptor of intraoperative performance. We aimed to characterize the intraoperative electrosurgical energy profile of bilateral TEP repairs performed by an experienced surgeon and to assess its consistency across cases, as a feasible preliminary step towards future objective referencing of energy profile usage in hernia surgery.
Methods: Eight adult patients undergoing elective bilateral TEP repair for primary, non-complex inguinal hernia between July 2023 and March 2024 were included in this prospective single-center observational study. Intraoperative electrosurgical data were captured by a data logger connected to the electrosurgical unit and synchronized with laparoscopic video. All procedures were performed by an experienced and specialized surgeon. The procedure was divided into nine phases; energy emitted per minute and the duty cycle per phase were analyzed, and inter-case consistency of the duty-cycle profile was quantified using Pearson correlation.
Results: A case-specific digital energy profile combining monopolar and bipolar use was mapped for each patient. Intervention duration ranged from 41 to 85 min (median 56.5), total activation duration from 2.09 to 5.45 min (median 3.77), and total emitted energy from 1670 to 7224 J (median 5043.5). Energy use was comparable between hernias of maximum EHS grade 1 and 2, whereas hernias of maximum EHS grade 3 showed more than 50% higher energy use. The duty cycle was highest during the main dissection phases and decreased toward parietalisation and this was consistent across the cases analysed. No postoperative complications occurred, and all patients were discharged the same day.
Conclusion: The intraoperative electrosurgical energy profile of bilateral TEP repairs by an experienced surgeon is reproducible across cases and resolves into a phase-specific pattern that mirrors the underlying surgical anatomy. This exploratory analysis provides a foundation for subsequent comparative studies in which trainees could objectively compare their electrosurgical behavior against an experienced reference, complementing existing learning aids in TEP and other phase-structured procedures.
期刊介绍：
Hernia was founded in 1997 by Jean P. Chevrel with the purpose of promoting clinical studies and basic research as they apply to groin hernias and the abdominal wall . Since that time, a true revolution in the field of hernia studies has transformed the field from a ”simple” disease to one that is very specialized. While the majority of surgeries for primary inguinal and abdominal wall hernia are performed in hospitals worldwide, complex situations such as multi recurrences, complications, abdominal wall reconstructions and others are being studied and treated in specialist centers. As a result, major institutions and societies are creating specific parameters and criteria to better address the complexities of hernia surgery.
Hernia is a journal written by surgeons who have made abdominal wall surgery their specific field of interest, but we will consider publishing content from any surgeon who wishes to improve the science of this field. The Journal aims to ensure that hernia surgery is safer and easier for surgeons as well as patients, and provides a forum to all surgeons in the exchange of new ideas, results, and important research that is the basis of professional activity.
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