Lim Jong Won, Lee Jin Yong, Lee Sang Eok, Moon Ju Ik, Ra Yu Mi, Choi In Seok, Choi Won Jun, Yoon Dae Sung, Min Hyun Sik
Department of Surgery, Konyang University College of Medicine, Daejeon, Korea.
J Korean Surg Soc. 2012 Aug;83(2):92-6. doi: 10.4174/jkss.2012.83.2.92. Epub 2012 Jul 25.
Laparoscopic totally extraperitoneal (TEP) herniorrhaphy has been recognized as a treatment option for inguinal hernia. The objective of this study was to clarify the learning curve for laparoscopic TEP herniorrhaphy using the moving average method.
A total of 90 patients underwent laparoscopic TEP herniorrhaphy by a single surgeon between March 2009 and March 2011. We analyzed medical records including the demographic data, operating time, hospital stay, and postoperative complications.
The mean operating time of the initial 30 cases (learning period group) was 66.3 minutes. After the initial 30 cases were performed, the time decreased to 52.8 minutes in the later 60 cases (experienced period group, P = 0.015). This represents the operating time becoming stabilized and then decreasing as the number of performed cases accumulates. Hospital stay was shorter and frequency of pain control, and complication rate were lower in the experienced period, however, there was no statistical significance.
We suggest that number of patients needed for the learning curve for laparoscopic TEP herniorrhaphy should be 30 cases. The operating time for laparoscopic TEP herniorrhaphy stabilizes after 40 cases in moving average analysis.
腹腔镜完全腹膜外（TEP）疝修补术已被公认为腹股沟疝的一种治疗选择。本研究的目的是使用移动平均法阐明腹腔镜TEP疝修补术的学习曲线。
2009年3月至2011年3月期间，共有90例患者由一名外科医生进行了腹腔镜TEP疝修补术。我们分析了包括人口统计学数据、手术时间、住院时间和术后并发症在内的病历。
最初30例（学习期组）的平均手术时间为66.3分钟。在完成最初30例手术后，后60例（经验期组）的时间降至52.8分钟（P = 0.015）。这表明随着手术例数的积累，手术时间趋于稳定然后下降。经验期的住院时间较短，疼痛控制频率和并发症发生率较低，但无统计学意义。
我们建议腹腔镜TEP疝修补术学习曲线所需的患者数量应为30例。在移动平均分析中，腹腔镜TEP疝修补术的手术时间在40例后趋于稳定。
