腹腔镜经腹腹膜前修补术的学习曲线：单外科医生连续 105 例手术的经验。
Learning curve for laparoscopic transabdominal preperitoneal repair: A single-surgeon experience of consecutive 105 procedures.
机构信息
Department of Coloproctology, Kenseikai Nara Coloproctology Center, Nara, Japan.
Department of Surgery, Nara Medical University, Nara, Japan.
出版信息
Asian J Endosc Surg. 2020 Apr;13(2):205-210. doi: 10.1111/ases.12724. Epub 2019 Jul 7.
INTRODUCTION
Based on previously published papers, the learning curve for laparoscopic groin hernia repair is controversial. The purpose of the present study was to evaluate the learning curve for laparoscopic surgery for groin hernia in a local hospital setting.
METHOD
We analyzed 100 consecutive cases of laparoscopic transabdominal preperitoneal repair performed by a single surgeon at a single facility from April 2013 to December 2015. The total operative time was divided into three parts: (a) preparing the peritoneal flap, (b) unfolding the mesh, and (c) suturing the peritoneum. A cumulative sum method for the total operative time and duration of the three parts was used to determine the learning curve.
RESULTS
The learning curve was overcome after 75 cases based on cumulative sum analysis of the total operative time. The cumulative sum analysis of the times to unfold mesh and to suture the peritoneum indicated that the learning curve was overcome after 22 and 32 cases, respectively. The learning curve for preparing the peritoneal space was correlated with that for the entire procedure. No cases of recurrence were encountered.
CONCLUSION
At least 75 cases were needed to overcome the learning curve for laparoscopic transabdominal preperitoneal repair.
简介
基于已发表的论文，腹腔镜腹股沟疝修补术的学习曲线存在争议。本研究的目的是评估在本地医院环境下腹腔镜腹股沟疝手术的学习曲线。
方法
我们分析了 2013 年 4 月至 2015 年 12 月期间由一位外科医生在一家医疗机构进行的 100 例连续腹腔镜经腹腹膜前修补术病例。总手术时间分为三个部分：（a）准备腹膜瓣，（b）展开网片，（c）缝合腹膜。采用总手术时间和三个部分的持续时间的累积和方法来确定学习曲线。
结果
根据总手术时间的累积和分析，学习曲线在 75 例后得到克服。展开网片和缝合腹膜的累积和分析表明，学习曲线在 22 例和 32 例后得到克服。准备腹膜空间的学习曲线与整个手术过程相关。未发生复发病例。
结论
腹腔镜经腹腹膜前修补术需要至少 75 例才能克服学习曲线。
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