Learning Curve of an Experienced Surgeon Transitioning to Totally Extraperitoneal Inguinal Hernia Repair Under the Guidance of a Senior Surgeon
DOI:
https://doi.org/10.58600/eurjther2929Keywords:
cumulative sum (CUSUM) analysis, inguinal hernia, laparoscopic training, learning curve, surgical education, totally extraperitoneal repairAbstract
Objective: This study aimed to objectively define the learning curve of an experienced general surgeon transitioning to TEP repair under non-interventional mentorship and to evaluate the effect of structured supervision on operative efficiency and safety.
Methods: Seventy-four male patients who underwent elective TEP repair between January 2021 and December 2024 were retrospectively analyzed. All procedures were performed by a single surgeon experienced in open and laparoscopic surgery but new to TEP repair, under real-time verbal supervision from a senior mentor who did not intervene physically. Learning progression was assessed using time-based and binary cumulative sum (CUSUM) analyses to determine thresholds for technical proficiency and surgical autonomy. Operative and postoperative outcomes were compared between the learning (cases 1–34) and proficiency (cases 35–74) phases.
Results: Time-based CUSUM identified technical proficiency after approximately 34 cases, suggesting stabilization of operative performance. The mean operative time decreased significantly from 82.5 ± 21.0 minutes in the learning phase to 55.1 ± 7.9 minutes in the proficiency phase, representing a 33.2% reduction (p < 0.001). Binary CUSUM analysis indicated a transition toward predominantly autonomous performance after around 22 cases; however, mentor consultation remained appropriate in technically complex cases, even during later stages of the learning curve. The rate of peritoneal rupture declined from 35.3% to 12.5% (p = 0.027). No major complications occurred, and conversion and recurrence rates remained comparable.
Conclusion: In this setting, structured, anatomy-guided verbal mentorship was associated with progressive improvements in operative efficiency and intraoperative safety during the early adoption of TEP repair by an experienced surgeon. Technical proficiency appeared to be reached after approximately 34 cases, while surgical autonomy evolved gradually rather than absolutely. These findings reflect the experience of a single surgeon–mentor pair and should be interpreted with caution; nevertheless, they suggest that non-interventional supervision may provide a safe and supportive educational framework for surgeons transitioning to TEP repair.
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