Background
Enhanced-view Total Extra-Peritoneal (eTEP) inguinal hernia repair is considered a technically demanding procedure with a steep learning curve
Aim: Examine the ability of residents to independently perform laparoscopic eTEP following a multimodal curriculum course.
Method: Prospective analysis of eTEP procedures performed by residents between March 2018 and September 2020. Six residents dispersed into 3 groups-group A: Two junior residents, group B: Two mid-level residents and group C: Two senior residents. The course comprised of theoretical and practical stages regarding eTEP in 5 steps. Data reviewed for each procedure included the time of each step, total time and autonomy degree as assessment for every step: 1st degreedependent (physical assistance), 2nd degree- partially dependent (vocal assistance) and 3rd degree-independent. Early and late procedures were divided at 50% of cases.
Results: Participants performed 44 procedures (220 steps). Late procedures presented with a significant improvement in all degrees of autonomy (1st degree p=0.002, 2nd degree p=0.007 and 3rd degree p<0.0001) and in every step (Step 1 p=0.015, Step 2 p=0.006, Step 3 p<0.0001, step 4 p<0.0001, step 5 p=0.002). There was no significant difference in surgery duration between early and late procedures (p=0.32). At early procedures junior residents needed significantly higher rates of physical intervention (1st degree) compared to the senior residents (p=0.004). Conversely, there was no significant difference in 2nd degree of autonomy (p=0.46), 3rd degree (p=0.06) and surgery duration (p=0.16). The last 3 procedures performed by all participants had no significant difference between the seniority groups in autonomy (1st degree p=0.1, 2nd degree p=0.18 and 3rd degree p=0.1).
Conclusion: A multimodal curriculum course is effective in achieving competence, autonomy and confidence in performing eTEP in a short time. This method of training reduces the learning curve of laparoscopic inguinal hernia repair.
Published Date: 2023-10-19; Received Date: 2023-09-04
