The Learning Curve for Laparoscopic Totally Extraperitoneal Herniorrhaphy by Logarithmic Function

Abstract

Purpose: Totally extraperitoneal (TEP) hernia repair has gained in popularity in the past two decades. Despite the advantages TEP hernia repair, the approach is hindered by the relatively long learning curve of the surgery. We tried to estimate the necessary number of repetitions of TEP hernia repair in the learning curve using logarithmic and exponential function models.Methods: We performed a retrospective review of all patients who underwent TEP hernia repair by a single surgeon consecutively at a single center. We calculated how many operations were needed to achieve a reduction in the expected operating time to mean operating time using logarithmic and exponential function models.Results: In the 91 patients, the logarithmic function model predicted that 37 cases were needed to overcome the learning curve for TEP hernia repair while the exponential model predicted that 39 cases were needed.Conclusion: According to this study, at least 37 to 39 cases are needed in the overcome learning curve of TEP hernia repair. Further studies are needed to optimize surgical education and maximize quality.