Wang Chih-Yuan, Chien Ti-Hsuan, Chien Chih-Ying
Department of General Surgery, Keelung Chang Gung Memorial Hospital, No 222, Maijin Rd., Anle Dist., Keelung City, 204201, Taiwan.
Surg Endosc. 2025 May;39(5):3337-3345. doi: 10.1007/s00464-025-11729-x. Epub 2025 Apr 16.
Most studies demonstrated that the learning curve of total extraperitoneal hernioplasty (TEP) is around 30-80 cases. All these studies were performed by a single surgeon who had little or no experience of TEP repair before. However, with mentoring by experienced surgeon, the second-generation surgeon may get more familiar with the anatomy and procedures of TEP than the pioneer surgeon. Besides, the surgical caveats would be further understood and pitfalls avoided by mentoring with the pioneer surgeon. The aims of this study were to investigate the effects of mentoring by pioneer surgeon to the second-generation surgeon in the TEP operation by comparing the learning curve and complications of pioneer and second-generation surgeon.
We retrospectively reviewed our TEP cases performed by the two surgeons, the pioneer surgeon and the second-generation surgeon, in general surgery department in Chang Gung Memorial Hospital, Keelung division. The reviewed period was between January 2016 and December 2021. The pioneer surgeon performed the TEP surgery by himself. The second-generation surgeon attended 20-30 cases of TEP done by pioneer surgeon. Then, the pioneer surgeon mentored the second-generation surgeon's first 10 TEP cases. By comparing the operation time, the intraoperative and post-operative complications, cumulative sum (CUSUM) learning curve was used for analysis.
The CUSUM analysis reveals that the learning curve of TEP is around 45 procedures in the pioneer surgeon and 30 procedures in the second-generation surgeon. The median operation time in pioneer surgeon and second-generation surgeon is 103.5 vs 90 min (p = 0.03). The overall intraoperative and post-operative complications between pioneer and second-generation surgeon reveal no significant difference. After crossing the learning curve, the operation time of pioneer surgeon and the second-generation surgeon decreased significantly, from 114 to 93 min (p = 0.008) and from 103 to 87.2min (p = 0.032), respectively. However, there was no significant difference in the overall post-operative complications.
By mentoring with the pioneer surgeon, the second-generation surgeon may achieve the learning curve quicker than the pioneer surgeon in terms of operation time. After reaching the learning curve, the operation time before and after learning curve reveal significant different in both surgeons while the overall post-operative complications reveal no significant different.
大多数研究表明，完全腹膜外疝修补术（TEP）的学习曲线约为30 - 80例。所有这些研究均由一名之前几乎没有或没有TEP修复经验的单一外科医生进行。然而，在经验丰富的外科医生的指导下，第二代外科医生可能会比先驱外科医生更熟悉TEP的解剖结构和手术步骤。此外，通过与先驱外科医生的指导，可以进一步理解手术注意事项并避免陷阱。本研究的目的是通过比较先驱外科医生和第二代外科医生的学习曲线及并发症，探讨先驱外科医生对第二代外科医生进行TEP手术指导的效果。
我们回顾性分析了长庚纪念医院基隆院区普通外科由两位外科医生，即先驱外科医生和第二代外科医生所进行的TEP病例。回顾期为2016年1月至2021年12月。先驱外科医生独自进行TEP手术。第二代外科医生观摩了先驱外科医生完成的20 - 30例TEP手术。然后，先驱外科医生指导第二代外科医生完成其最初的10例TEP手术。通过比较手术时间、术中及术后并发症，采用累积和（CUSUM）学习曲线进行分析。
CUSUM分析显示，先驱外科医生TEP的学习曲线约为45例手术，第二代外科医生约为30例手术。先驱外科医生和第二代外科医生的中位手术时间分别为103.5分钟和90分钟（p = 0.03）。先驱外科医生和第二代外科医生之间的总体术中及术后并发症无显著差异。越过学习曲线后，先驱外科医生和第二代外科医生的手术时间均显著下降，分别从114分钟降至93分钟（p = 0.008）和从103分钟降至87.2分钟（p = 0.032）。然而，总体术后并发症无显著差异。
通过先驱外科医生的指导，第二代外科医生在手术时间方面可能比先驱外科医生更快达到学习曲线。达到学习曲线后，两位外科医生学习曲线前后的手术时间有显著差异，而总体术后并发症无显著差异。
