Lau H, Patil N G, Yuen W K, Lee F
Department of Surgery, University of Hong Kong Medical Center, Tung Wah Hospital, 12 Po Yan Street, Sheung Wan, Hong Kong.
Surg Endosc. 2002 Dec;16(12):1724-8. doi: 10.1007/s00464-001-8298-0. Epub 2002 Jul 8.
Performance of endoscopic totally extraperitoneal inguinal hernioplasty (TEP) requires specialized anatomical knowledge and surgical dexterity. The present study was undertaken to evaluate the learning curve for a general surgeon to master the technique of TEP in the absence of an experienced supervisor.
A retrospective analysis of the first 120 consecutive unilateral TEPs was performed. Medical records were reviewed to evaluate demographic features, perioperative outcome, and follow-up results. The study population was divided into six consecutive groups of 20 patients. Clinical data were compared among the groups to evaluate the impact of operative experience on perioperative outcome.
Operative time was the only clinical parameter that showed significant improvement with experience; it reached a plateau value of <1 h after the fourth group. Conversions to transabdominal and open approaches were required in only one patient in groups 1 and 6, respectively. Comparison of demographic features, hernia types, postoperative morbidity rates, length of hospital stay, and number of days to resume normal activities showed no significant differences among the groups. All complications were minor and resolved uneventfully. No recurrence was detected during follow-up.
The learning curve for unilateral TEP by a general surgeon peaked after performing 80 procedures. In most cases, unilateral TEP can be accomplished safely within 1 h. Even during the learning process, TEP carries a low morbidity and conversion rate.
内镜完全腹膜外腹股沟疝修补术（TEP）的实施需要专业的解剖学知识和手术技巧。本研究旨在评估普通外科医生在没有经验丰富的上级医生指导的情况下掌握TEP技术的学习曲线。
对连续进行的前120例单侧TEP手术进行回顾性分析。查阅病历以评估人口统计学特征、围手术期结果和随访结果。研究人群被连续分为6组，每组20例患者。比较各组的临床数据，以评估手术经验对围手术期结果的影响。
手术时间是唯一随经验增加而有显著改善的临床参数；在第四组之后，手术时间达到了<1小时的稳定值。第1组和第6组分别只有1例患者需要转为经腹和开放手术方式。比较各组的人口统计学特征、疝类型、术后发病率、住院时间和恢复正常活动的天数，差异均无统计学意义。所有并发症均为轻微，且顺利解决。随访期间未发现复发。
普通外科医生进行单侧TEP手术时，学习曲线在完成80例手术后达到峰值。在大多数情况下，单侧TEP可在1小时内安全完成。即使在学习过程中，TEP的发病率和中转率也较低。
