Laparoscopic extraperitoneal inguinal hernia repair versus open mesh repair: a prospective randomized controlled trial. Andersson B - Surgery - 01-MAY-2003; 133(5): 464-72
The learning curve for TEP is increased compared with both conventional hernia surgery 21 and TAPP.18
TEP has been suggested to be undertaken only by experienced laparoscopic surgeons who have performed more than 100 laparoscopic cholecystectomies. 21
21. Liem MS, van Steensel CJ, Boelhouwer RU, Weidema WF, Clevers GJ, Meijer WS, et al. The learning curve for totally extraperitoneal laparoscopic inguinal hernia repair. Am J Surg 1996;171:281-5.
18. Kald A, Anderberg B, Smedh K, Karlsson M. Transperitoneal or totally extraperitoneal approach in laparoscopic hernia repair: results of 491 consecutive herniorrhaphies. Surg Laparosc Endosc 1997;7:86-9.
Open Mesh versus Laparoscopic Mesh Repair of Inguinal Hernia Leigh Neumayer, M.D., Anita Giobbie-Hurder, M.S., Olga Jonasson, M.D., Robert Fitzgibbons, Jr., M.D., Dorothy Dunlop, Ph.D., James Gibbs, Ph.D., Domenic Reda, Ph.D., and William Henderson, Ph.D., for the Veterans Affairs Cooperative Studies Program 456 Investigators* n engl j med 350;18 29, 2004
The recurrence rate associated with laparoscopic repair was greater than 10 % for the 58 surgeons who reported having performed 250 or fewer laparoscopic repairs in any category,
The recurrence rate was less than 5 % for the 20 surgeons who reported having performed more than 250 laparoscopic repairs
For open repairs, there was no significant difference in the rate of recurrence between the most experienced group of surgeons (those who had performed more than 250 repairs) and surgeons with less experience
Groin Hernia Repair by Laparoscopic Techniques: Current Status and Controversies Maurice E. Arregui1 and Susan B. Young1 World Journal of Surgery Société Internationale de Chirurgie 2005 10.1007/s00268-005-7968-9
The learning curve for a proper repair is greater than that of most laparoscopic procedures.
Although some have estimated that the learning curve is in the range of 30 to 50 procedures
Davis CJ, Arregui ME. Laparoscopic repair for groin hernias. Surg. Clin. North Am. 2003;83:1141–1161
The multiinstitutional Veterans Affairs study suggests that the number may be much higher [ 1 ].
Laparoscopic total extraperitoneal (TEP) inguinal hernia repair Overcoming the learning curve Pawanindra Lal, R. K. Kajla, J. Chander, V. K. Ramteke Surg Endosc (2004) 18: 642–645
We strongly recommend a minimum of 10 open Stoppa’s preperitoneal procedures, to enable a trained laparoscopic surgeon to start laparoscopic TEP operation independently and in the absence of another trained laparoscopic hernia surgeon, whose presence may not prevent complications and recurrences.
Totally Extraperitoneal (TEP) Approach for Inguinal Hernia: The Favorable Learning Curve for Trainees Jaime Haidenberg, MD, Michael L. Kendrick, MD, Tobias Meile, MD, and David R. Farley, MD CURRENT SURGERY • Volume 60/Number 1 • January/February 2003
In repairing over 2000 groin hernias over the past decade at an academic center, the senior author can attest that the TEP technique is conceptually easier to pass on to Mayo trainees than are modified Bassini, Lichtenstein, or mesh-plug techniques.
The duration of the operation and successful outcome (based on complications and recurrence) was no different among PG-1, 2, 3, 4, or 5 level residents performing the procedure under staff supervision.
Laparoscopic repair for groin hernias Chad J. Davis, MD*, Maurice E. Arregui, MD Surg Clin N Am 83 (2003) 1141–1161
Some investigators have addressed the subject and shown that as the surgeon becomes more experienced, operating times, conversions to an open procedure, complications, and recurrences all decrease [17,53–56].
It is not known precisely how many operations are required to attain proficiency, but 30 to 50 appears to be the range [17,54–56].