The Learning Curve for Laparoscopic Totally Extraperitoneal Herniorrhaphy by Logarithmic Function: Consecutive 291 cases Performed by a Single Surgeon

Purpose: The Totally extraperitoneal (TEP) herniorrhaphy is not an easy technique for beginner surgeons because of the complexity of inguinal anatomy and narrow space of the operation field. The aim of this study is to estimate learning curve of laparoscopic TEP herniorrhaphy using logarithmic function model and the exponential function model. Revealing the number of cases needs to overcoming the early learning curve and minimizing the recurrence rate. Methods: A retrospective analysis of the first 291 patient who underwent laparoscopic TEP herniorrhaphy by a single surgeon consecutively. A logarithmic function and an exponential function were derived from operating time data. The population was divided into three consecutive groups. Each groups assigned the starting point, the slope of the curve, and the plateau of the curve. We calculated how many operation numbers are needed to achieve reduction expected operating time to mean operating time. Results: 291 patients underwent laparoscopic hernia repair. The mean operation time was 70.3 minutes for unilateral hernias. According to two learning curve models, the operation time was decreased less than mean operation time after the initial 88 cases was performed. As the operation time decreased, the recurrence rate decreased. Conclusion: According to the two learning curve models, 88 cases are required to overcome the learning curve, minimize revision surgery, and achieve a qualified surgery. Further studies on learning curves and training methods are needed to enable a scientific approach to surgical education and quality improvement in surgical education for surgeons and medical services for patients.