AlJamal Yazan N, Zendejas Benjamin, Gas Becca L, Ali Shahzad M, Heller Stephanie F, Kendrick Michael L, Farley David R
Department of Surgery, Mayo Clinic College of Medicine , Rochester, Minnesota.
J Laparoendosc Adv Surg Tech A. 2016 Feb;26(2):92-8. doi: 10.1089/lap.2015.0368. Epub 2016 Jan 28.
Data on laparoscopic totally extraperitoneal inguinal hernia repairs (TEP-IHRs) suggest that approximately 250 operations are needed to gain mastery, but the annual volume required to maintain high-quality outcomes is unknown.
A retrospective review was performed of every patient undergoing a TEP-IHR at the Mayo Clinic (Rochester, MN) from 1995 to 2011. Analysis focused on the annual volume of 21 staff surgeons and their specific patient outcomes broken up into three groups: Group 1 (G1) (n = 1 surgeon) performed >30 repairs per year; Group 2 (G2) (n = 3 surgeons), 15-30 repairs; and Group 3 (G3) (n = 17), <15 repairs.
In total, 1601 patients underwent 2410 TEP-IHRs, with no significant patient demographic differences among groups. Greater annual surgeon volume (G1 > G2 > G3) was associated with improved outcomes as shown by the respective rates for intra- (1%, 2.6%, and 5.6%) and postoperative (13%, 27%, and 36%) complications, need for overnight stay (17%, 23%, and 29%), and hernia recurrence (1%, 4%, and 4.3%) (all P < .05). Surgeons with greater annual operative volumes were more likely to operate on patients with bilateral and recurrent hernias. Surgeons performing at least 15 repairs per year (G1 and G2) showed improvements in quality metrics over time.
Annual operative volumes of >30 repairs per year are associated with the highest quality outcomes for TEP-IHR. Operative volumes of at least 15 repairs per year are associated with improvements in quality metrics over time. Mentorship and operative assistance of low-volume TEP-IHR surgeons may be useful in improving patient outcomes.
腹腔镜完全腹膜外腹股沟疝修补术（TEP - IHRs）的数据表明，要熟练掌握该技术大约需要进行250例手术，但维持高质量手术效果所需的年手术量尚不清楚。
对1995年至2011年在梅奥诊所（明尼苏达州罗切斯特）接受TEP - IHR手术的每一位患者进行回顾性研究。分析聚焦于21名外科医生的年手术量及其特定患者的手术结果，将其分为三组：第1组（G1）（n = 1名外科医生）每年进行超过30例修补手术；第2组（G2）（n = 3名外科医生），每年进行15 - 30例修补手术；第3组（G3）（n = 17名外科医生），每年进行少于15例修补手术。
共有1601例患者接受了2410例TEP - IHR手术，各组患者的人口统计学特征无显著差异。外科医生年手术量越大（G1 > G2 > G3），手术效果越好，具体表现为术中（分别为1%、2.6%和5.6%）及术后（分别为13%、27%和36%）并发症发生率、过夜住院需求率（分别为17%、23%和29%）以及疝复发率（分别为1%、4%和4.3%）均较低（所有P < 0.05）。年手术量较大的外科医生更有可能为双侧疝和复发性疝患者进行手术。每年至少进行15例修补手术的外科医生（G1和G2）随着时间推移在质量指标方面有所改善。
每年进行超过30例修补手术的年手术量与TEP - IHR的最高质量手术效果相关。每年至少进行15例修补手术的手术量与随着时间推移质量指标的改善相关。对低年手术量的TEP - IHR外科医生进行指导和手术协助可能有助于改善患者手术效果。
