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Bauer K, Vogel R, Heinzelmann F, Büchler P, Mück B. Robotic-assisted surgery for lateral ventral hernias - experience of robot-assisted methods for retromuscular and preperitoneal abdominal wall reconstruction. Hernia 2024:10.1007/s10029-024-03132-7. [PMID: 39177907 DOI: 10.1007/s10029-024-03132-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 08/05/2024] [Indexed: 08/24/2024]
Abstract
BACKGROUND Due to the proximity to bony structures and the complex anatomy of the three-layered lateral abdominal wall, the surgical treatment of lateral ventral hernias is technically demanding. With this study we would like to demonstrate how lateral abdominal wall hernias can be treated using new robotic surgical techniques with extraperitoneal mesh placement. OBJECTIVES The purpose of this study is to demonstrate that the application of the robot in minimally invasive treatment of lateral abdominal wall hernias is safe and efficient. MATERIALS AND METHODS A retrospective analysis of all patients who underwent robotically-assisted lateral ventral hernia repair surgery from June 2019 to December 2023 was performed. RESULTS A total of 50 ventral hernias were operated robotically due to a lateral hernia in the study period. 45 patients had an incisional hernia and 5 patients a primary spighelian hernia. 27 patients had only lateral findings, whereas 23 patients had combined hernias with lateral and medial hernial defects. 18 patients were treated with a preperitoneal mesh (r-vTAPP). 31 patients required TAR to achieve complete fascial closure and sufficient mesh overlap (24 extraperitoneal approach r-eTAR/7 transperitonel approach r-TAR). One patient had to be converted intraoperatively from a planned preperitoneal mesh to an intraperitoneal mesh repair (r-IPOM). The median hernia defect area was 71 cm² (3-375 cm²). The median mesh size was 600 cm² (150-1290 cm²). The median mesh defect ratio (MDR) was 10 (2,33-133,33). Five postoperative complications were encountered (10%). Two reoperations (4%) were required. CONCLUSION The utilization of new robotic surgical techniques provides a safe minimally invasive treatment option even for complex lateral ventral hernias that previously posed difficulties in surgical management. The early postoperative results show promising outcomes.
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Affiliation(s)
- K Bauer
- Department of General and Visceral Surgery, Klinikum Kempten - Klinikverbund Allgäu, Kempten, Germany
| | - R Vogel
- Department of General and Visceral Surgery, Klinikum Kempten - Klinikverbund Allgäu, Kempten, Germany
| | - F Heinzelmann
- Department of General and Visceral Surgery, Klinikum Kempten - Klinikverbund Allgäu, Kempten, Germany
| | - P Büchler
- Department of General and Visceral Surgery, Klinikum Kempten - Klinikverbund Allgäu, Kempten, Germany
| | - Björn Mück
- Department of General and Visceral Surgery, Klinikum Kempten - Klinikverbund Allgäu, Kempten, Germany.
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Espinosa-de-los-Monteros A, Fernandez-Alva D, Solis-Reyna RA, de-la-Garza-Elizondo CA, Vazquez-Guadalupe J, Posadas-Trujillo OE, Diaz-Trueba FE. Comparison of open anterior component and open transversus abdominus release in repair of large subcostal hernias. PLoS One 2023; 18:e0288571. [PMID: 38157343 PMCID: PMC10756514 DOI: 10.1371/journal.pone.0288571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 12/12/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND Large subcostal incisional hernias are considered as complex defects, and a few different approaches have been described for repair. The purpose of this comparative cross-sectional study is to evaluate the outcomes of patients with large subcostal incisional hernias treated with either the open anterior components separation technique (ACS) or with the open transversus abdominis release technique (TAR). METHODS From the database of patients with large complex incisional hernias who underwent abdominal wall reconstruction with open techniques between April 2007 and October 2022 at our institution, on May 25th, 2023 we identified those whose hernias were located in the subcostal areas and who underwent reconstruction with a components separation technique and mesh. Perioperative variables and outcomes were compared between the patients with large subcostal hernias who underwent abdominal wall reconstruction with either the ACS or the TAR techniques. RESULTS Thirty-one patients with large subcostal hernias were included in the study. ACS and intra-abdominal mesh was used in 11 patients; TAR and retro-muscular mesh was performed in 20 patients. More postoperative local abdominal wall complications were seen in patients who had ACS as opposed to TAR (55% vs 15%, p = 0.02). Hernia recurrence was more common in patients who had ACS as opposed to TAR (55% vs 5%, p = 0.008). CONCLUSIONS More post-operative complications and recurrences were seen in patients who had ACS as opposed to TAR.
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Affiliation(s)
| | - Daniela Fernandez-Alva
- Department of Plastic Surgery, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | - Rodrigo Alejandro Solis-Reyna
- Department of Plastic Surgery, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | | | - Joseph Vazquez-Guadalupe
- Department of Plastic Surgery, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | | | - Flavio Enrique Diaz-Trueba
- Department of General Surgery, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
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Zuvela M, Galun D, Bogdanovic A, Bidzic N, Zivanovic M, Zuvela M, Zuvela M. The Modified Sublay Technique for the Management of Major Subcostal Incisional Hernia: Long-Term Follow-up Results of 37 Consecutive Patients. Ann Plast Surg 2022; 88:212-218. [PMID: 34176897 DOI: 10.1097/sap.0000000000002890] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The aims of this study were to present the concept of original technique in the management of major incisional subcostal hernias and to evaluate short- and long-term outcome. METHOD Between January 2010 and January 2020, 280 patients underwent hernia repair surgery for incisional lateral abdominal hernia at Clinic for Digestive Surgery, Clinical Center of Serbia. Among them, 37 patients underwent the modified sublay technique for major incisional subcostal hernia with minimal hernia defect surface of 100 cm2 or greater or minimal hernia defect width or height of 10 cm or greater. The operative techniques are as follows: retromuscular dissection of rectus muscle from posterior sheath on the both sides of hernia defect, external oblique muscle dissection from internal oblique muscle in a circle around hernia defect at the side of the hernia defect, complete reconstruction of the posterior myofascial layer, large heavyweight polypropylene mesh placement in a sublay position, and complete or partial reconstruction of anterior myofascial layer. RESULTS A median (range) hernia defect surface was 150 (100-500) cm2. A median operative time was 130 (90-330) minutes. The morbidity rate was 18.9%. A median (range) postoperative hospital stay was 7 (2-24) days. After the median follow-up of 50 (1-108) months, 2 patients (5.4%) developed recurrent hernia. CONCLUSIONS The modified sublay technique using large heavyweight polypropylene mesh provides good results in the management of major subcostal abdominal wall defects.
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Affiliation(s)
| | | | | | | | - Marko Zivanovic
- From the Clinic for Digestive Surgery, Clinical Center of Serbia
| | - Milos Zuvela
- From the Clinic for Digestive Surgery, Clinical Center of Serbia
| | - Milan Zuvela
- From the Clinic for Digestive Surgery, Clinical Center of Serbia
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Cabrera ATG, Lima DL, Pereira X, Cavazzola LT, Malcher F. ROBOTIC TRANS-ABDOMINAL PREPERITONEAL APPROACH (TAPP) APPROACH FOR LATERAL INCISIONAL HERNIAS. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2021; 34:e1599. [PMID: 34669888 PMCID: PMC8521837 DOI: 10.1590/0102-672020210002e1599] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 02/25/2021] [Indexed: 11/21/2022]
Abstract
Background:
Lateral incisional hernias arise between the linea alba and the posterior paraspinal muscles. Anatomical boundaries contain various topographic variations, such as multiple nearby bony structures and paucity of aponeurotic tissue that make it particularly challenging to repair.
Aim:
To describe a robotic assisted surgical technique for incisional lumbar hernia repair.
Methods:
Retrospective data was collected from four patients who underwent robotic-assisted repair of their lumbar hernias after open nephrectomies.
Results: Age ranged from 41-53 y. Two patients had right sided flank hernias while the other two on the left. One patient had a recurrent hernia on the left side. The patients were placed in lateral decubitus position contralateral to the hernia defect side. A trans-abdominal preperitoneal approach was used in all cases. Each case was accomplished with two 8 mm robotic ports, a 12 mm periumbilical port, and a 5 mm assistance port that allowed docking on the ipsilateral hernia side. The hernias were identified, a preperitoneal plane was created, and the hernia sac completely dissected allowing for complete visualization of the defect. All defects were primarily closed. Polypropylene or ProGripTM mesh was applied with at least 5 cm overlap and secured using either #0 Vicryl® transfacial sutures, Evicel® or a combination of both. The peritoneal space was closed with running suture and the ports were removed and closed. The average surgical length was 4 hr. The post-operative length of stay ranged from 0-2 days.
Conclusion:
The robotics platform may provide unique advantages in the repair of lateral incisional hernias and represents a safe, feasible and effective minimally invasive approach for the correction of lateral incisional hernias.
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Affiliation(s)
| | | | - Xavier Pereira
- Montefiore Medical Center, Department of Surgery, The Bronx, New York, USA
| | | | - Flavio Malcher
- Montefiore Medical Center, Department of Surgery, The Bronx, New York, USA
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Li B, Qin C, Yu J, Gong D, Nie X, Li G, Bittner R. Totally endoscopic sublay (TES) repair for lateral abdominal wall hernias: technique and first results. Hernia 2021; 25:523-533. [PMID: 33599899 DOI: 10.1007/s10029-021-02374-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 01/22/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND The optimal surgical treatment for lateral hernias of the abdominal wall remains unclear. The presented prospective study assesses for the first time in detail the clinical value of a totally endoscopic sublay (TES) technique for the repair of these hernias. METHODS Twenty-four consecutive patients with a lateral abdominal wall hernia underwent TES repair. This technique is naturally combined with a transversus abdominis release maneuver to create a sufficient retromuscular/preperitoneal space that can accommodate, if necessary, a giant prosthetic mesh. RESULTS The operations were successful in all but one patient who required open conversion because of dense intestinal adhesion. The mean defect width was 6.7 ± 3.9 cm. The mean defect area was 78.0 ± 102.4 cm2 (range 4-500 cm2). The mean mesh size used was 330.2 ± 165.4 cm2 (range 108-900 cm2). The mean operative time was 170.2 ± 73.8 min (range, 60-360 min). The mean visual analog scale score for pain at rest on the first day was 2.5 (range 1-4). The average postoperative stay was 3.4 days (range 2-7 days). No serious complications (Dindo-Clavien Grade 2-4) were seen within a mean follow-up period of 13.3 months. CONCLUSIONS A totally endoscopic technique (TES) for the treatment of lateral hernias is described. The technique revealed to be reliable, safe and cost-effective. The first results are promising, but larger studies with longer follow-up periods are recommended to determine the real clinical value.
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Affiliation(s)
- B Li
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, 510515, China
| | - C Qin
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100043, China
| | - J Yu
- Department of General Surgery, School of Medicine, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, Shanghai, 201999, China
| | - D Gong
- Department of General Surgery, The First School of Clinical Medicine of Southern Medical University, Guangzhou, 511400, China
| | - X Nie
- Department of General Surgery, The First School of Clinical Medicine of Southern Medical University, Guangzhou, 511400, China
| | - G Li
- Department of General Surgery, The First School of Clinical Medicine of Southern Medical University, Guangzhou, 511400, China.
| | - R Bittner
- Emeritus Director Marienhospital Stuttgart, Supperstr. 19, 70565, Stuttgart, Germany.
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Robotic repair of lateral incisional hernias using intraperitoneal onlay, preperitoneal, and retromuscular mesh placement: a comparison of mid-term results and surgical technique. Eur Surg 2020. [DOI: 10.1007/s10353-020-00634-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Tsujinaka S, Nakabayashi Y, Kakizawa N, Kikugawa R, Toyama N, Rikiyama T. Laparoscopic and percutaneous repair of a large midline incisional hernia extending to the bilateral subcostal region: A case report. Int J Surg Case Rep 2018; 47:14-18. [PMID: 29704737 PMCID: PMC5994712 DOI: 10.1016/j.ijscr.2018.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 04/08/2018] [Accepted: 04/15/2018] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Optimal surgery for a midline incisional hernia extending to the subcostal region remains unclear. We report successful hybrid laparoscopic and percutaneous repair for such a complex incisional hernia. PRESENTATION OF CASE An 85-year-old woman developed a symptomatic incisional hernia after open cholecystectomy. Computed tomography revealed a 14 × 10 cm fascial defect. Four trocars were placed under general anesthesia. Percutaneous defect closure was performed using multiple non-absorbable monofilament threads, i.e., a "square stitch." Each thread was inserted into the abdominal cavity from the right side of the defect and pulled out to the left side. The right side of the thread was subcutaneously introduced anterior to the hernia sac. The threads were sequentially tied in a cranial to caudal direction. A multifilament polyester mesh with resorbable collagen barrier was selected and fixed using absorbable tacks with additional full-thickness sutures. The cranial-most limit of mesh fixation was at the level of the subcostal margin, and the remaining part was draped over the liver surface. The postoperative course was uneventful, with no seroma, mesh bulge, or hernia recurrence at 1, 3, 6, and 12 months of follow-up. DISCUSSION The advantages of our technique are the minimal effect on the scar in the midline during defect closure, the minimal damage to the ribs and obtaining more overlap during mesh fixation. The disadvantage is the postoperative pain. CONCLUSION Our proposed hybrid surgical approach may be considered as the treatment of choice for a large midline incisional hernia extending to the bilateral costal region.
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Affiliation(s)
- Shingo Tsujinaka
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847, Amanumacho, Omiya, Saitama-shi, Saitama 330-8503, Japan.
| | - Yukio Nakabayashi
- Department of Surgery, Kawaguchi Municipal Medical Center, 180, Nishiaraijuku, Kawaguchi, Saitama 333-0833, Japan.
| | - Nao Kakizawa
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847, Amanumacho, Omiya, Saitama-shi, Saitama 330-8503, Japan.
| | - Rina Kikugawa
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847, Amanumacho, Omiya, Saitama-shi, Saitama 330-8503, Japan.
| | - Nobuyuki Toyama
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847, Amanumacho, Omiya, Saitama-shi, Saitama 330-8503, Japan.
| | - Toshiki Rikiyama
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847, Amanumacho, Omiya, Saitama-shi, Saitama 330-8503, Japan.
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Invited comment to: Open retromuscular large mesh reconstruction of lumbar incisional hernias including the atrophic muscular area. Y. Renard, L. de Mestier, A. Cagniet et al. Hernia 2017; 21:351-353. [PMID: 28364291 PMCID: PMC5435796 DOI: 10.1007/s10029-017-1600-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 03/22/2017] [Indexed: 11/06/2022]
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Ferrarese A, Buccelli C, Addeo G, Capasso E, Conti A, Amato M, Compagna R, Niola M, Martino V. Excellence and safety in surgery require excellent and safe tutoring. Open Med (Wars) 2016; 11:518-522. [PMID: 28352844 PMCID: PMC5329876 DOI: 10.1515/med-2016-0089] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 10/31/2016] [Indexed: 11/15/2022] Open
Abstract
The surgical education in Italy has always been a very important issue. The aim of this article is to bring together the feedback of the definitions of the various components of the learning scheme and to evaluate the importance of the legal point. In March 2016 we performed a literature review. We have also examinated the internet pages of the Italian Department of Education, Health and Medical Order. In Italy the tutor had an unclear role from a legal point of view. He is the person who must be able to perform a specific procedure with expert technical and who must know how to stop the student if this is about to perform a dangerous maneuver. In Italy the ability to work for the trainee is limited in all reality, it depends on several factors including the increase of numbers of medical-legal disputes, the timing, the commitment it requires mentoring and a lack of mentors. Conclusion: In surgery, the problem is greater because of the increasingly of medico-legal implications that we are after surgical procedure. It would be necessary to define a role of the tutor in a regular protocol and a proper assessment of his performance.
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Affiliation(s)
- Alessia Ferrarese
- Department of Oncology, University of Turin, Section of General Surgery, San Luigi Gonzaga University Hospital, Regione Gonzole 10, 10043 Orbassano, Turin, Italy . Tel: +39 0119026224
| | - Claudio Buccelli
- Department of Advanced Biomedical Sciences, Naples, Italy, University "Federico II" of Naples, Naples, Italy
| | - Giuseppe Addeo
- Department of Advanced Biomedical Sciences, Naples, Italy, University "Federico II" of Naples, Naples, Italy
| | - Emanuele Capasso
- Department of Advanced Biomedical Sciences, Naples, Italy, University "Federico II" of Naples, Naples, Italy
| | - Adelaide Conti
- Department of Surgery, Radiology and Public Health, Public Health and Humanities Section, University of Brescia, Centre of Bioethics Research (with the contribution of IRCCS "S.Giovanni di Dio - Fatebenefratelli"), 25123 Brescia, Italy
| | - Maurizio Amato
- Department of Neuroscience, Naples, Italy. Fellow in General Surgery at University of Naples, Italy
| | - Rita Compagna
- Department of Public Health, Naples, Italy. Fellow in Vascular Surgery at University of Naples, Italy
| | - Massimo Niola
- Department of Advanced Biomedical Sciences, Naples, Italy, University "Federico II" of Naples, Naples, Italy
| | - Valter Martino
- University of Turin, Department of Oncology, School of Medicine, San Luigi Gonzaga University Hospital, Section of General Surgery, Orbassano, Turin, Italy
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Borello A, Ferrarese A, Passera R, Surace A, Marola S, Buccelli C, Niola M, Di Lorenzo P, Amato M, Di Domenico L, Solej M, Martino V. Use of a simplified consent form to facilitate patient understanding of informed consent for laparoscopic cholecystectomy. Open Med (Wars) 2016; 11:564-573. [PMID: 28352847 PMCID: PMC5329879 DOI: 10.1515/med-2016-0092] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 10/31/2016] [Indexed: 12/26/2022] Open
Abstract
Background Surgical informed consent forms can be complicated for patients to read and understand. We created a consent form with key information presented in bulleted texts and diagrams combined in a graphical format to facilitate the understanding of information during the verbal consent discussion. Methods This prospective, randomized study involved 70 adult patients awaiting cholecystectomy for gallstones. Consent was obtained after standard verbal explanation using either a graphically formatted (study group, n=33) or a standard text document (control group, n=37). Comprehension was evaluated with a 9-item multiple-choice questionnaire administered before surgery and factors affecting comprehension were analyzed. Results Comparison of questionnaire scores showed no effect of age, sex, time between consent and surgery, or document format on understanding of informed consent. Educational level was the only predictor of comprehension. Conclusions Simplified surgical consent documents meet the goals of health literacy and informed consent. Educational level appears to be a strong predictor of understanding.
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Affiliation(s)
- Alessandro Borello
- University of Turin, Department of Oncology, School of Medicine, San Luigi Gonzaga University Hospital, Section of General Surgery, Orbassano, Turin, Italy
| | - Alessia Ferrarese
- Department of Oncology, University of Turin, Section of General Surgery, San Luigi Gonzaga University Hospital, Regione Gonzole 10, 10043 Orbassano, Turin, Italy ,
| | - Roberto Passera
- Città della Salute e della Scienza Hospital, Section of Nuclear Medicine, Turin, Italy
| | - Alessandra Surace
- University of Turin, Department of Oncology, School of Medicine, San Luigi Gonzaga University Hospital, Section of General Surgery, Orbassano, Turin, Italy
| | - Silvia Marola
- University of Turin, Department of Oncology, School of Medicine, San Luigi Gonzaga University Hospital, Section of General Surgery, Orbassano, Turin, Italy
| | - Claudio Buccelli
- Department of Advanced Biomedical Sciences, Naples, Italy, University "Federico II" of Naples. Via Sergio Pansini 5, 80131, Naples, Italy
| | - Massimo Niola
- Department of Advanced Biomedical Sciences, Naples, Italy, University "Federico II" of Naples. Via Sergio Pansini 5, 80131, Naples, Italy
| | - Pierpaolo Di Lorenzo
- Department of Advanced Biomedical Sciences, Naples, Italy, University "Federico II" of Naples. Via Sergio Pansini 5, 80131, Naples, Italy
| | - Maurizio Amato
- Department of Neuroscience, Naples, Italy. Fellow in General Surgery at University of Naples, Naples, Italy
| | - Lorenza Di Domenico
- Department of Neuroscience, Naples, Italy. Fellow in Anestesiology at University of Naples, Naples, Italy
| | - Mario Solej
- University of Turin, Department of Oncology, School of Medicine, San Luigi Gonzaga University Hospital, Section of General Surgery, Orbassano, Turin, Italy
| | - Valter Martino
- University of Turin, Department of Oncology, School of Medicine, San Luigi Gonzaga University Hospital, Section of General Surgery, Orbassano, Turin, Italy
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Ferrarese A, Gentile V, Bindi M, Rivelli M, Cumbo J, Solej M, Enrico S, Martino V. The learning curve of laparoscopic holecystectomy in general surgery resident training: old age of the patient may be a risk factor? Open Med (Wars) 2016; 11:489-496. [PMID: 28352841 PMCID: PMC5329873 DOI: 10.1515/med-2016-0086] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 10/11/2016] [Indexed: 01/27/2023] Open
Abstract
A well-designed learning curve is essential for the acquisition of laparoscopic skills: but, are there risk factors that can derail the surgical method? From a review of the current literature on the learning curve in laparoscopic surgery, we identified learning curve components in video laparoscopic cholecystectomy; we suggest a learning curve model that can be applied to assess the progress of general surgical residents as they learn and master the stages of video laparoscopic cholecystectomy regardless of type of patient. Electronic databases were interrogated to better define the terms “surgeon”, “specialized surgeon”, and “specialist surgeon”; we surveyed the literature on surgical residency programs outside Italy to identify learning curve components, influential factors, the importance of tutoring, and the role of reference centers in residency education in surgery. From the definition of acceptable error, self-efficacy, and error classification, we devised a learning curve model that may be applied to training surgical residents in video laparoscopic cholecystectomy. Based on the criteria culled from the literature, the three surgeon categories (general, specialized, and specialist) are distinguished by years of experience, case volume, and error rate; the patients were distinguished for years and characteristics. The training model was constructed as a series of key learning steps in video laparoscopic cholecystectomy. Potential errors were identified and the difficulty of each step was graded using operation-specific characteristics. On completion of each procedure, error checklist scores on procedure-specific performance are tallied to track the learning curve and obtain performance indices of measurement that chart the trainee’s progress. Conclusions. The concept of the learning curve in general surgery is disputed. The use of learning steps may enable the resident surgical trainee to acquire video laparoscopic cholecystectomy skills proportional to the instructor’s ability, the trainee’s own skills, and the safety of the surgical environment. There were no patient characteristics that can derail the methods. With this training scheme, resident trainees may be provided the opportunity to develop their intrinsic capabilities without the loss of basic technical skills.
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Affiliation(s)
- Alessia Ferrarese
- Department of Oncology, University of Turin, Section of General Surgery, San Luigi Gonzaga Teaching Hospital, Regione Gonzole 10, 10043 Orbassano, Turin, Italy
| | - Valentina Gentile
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital "San Luigi Gonzaga", Section of General Surgery, Orbassano, Turin, Italy
| | - Marco Bindi
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital "San Luigi Gonzaga", Section of General Surgery, Orbassano, Turin, Italy
| | - Matteo Rivelli
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital "San Luigi Gonzaga", Section of General Surgery, Orbassano, Turin, Italy
| | - Jacopo Cumbo
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital "San Luigi Gonzaga", Section of General Surgery, Orbassano, Turin, Italy
| | - Mario Solej
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital "San Luigi Gonzaga", Section of General Surgery, Orbassano, Turin, Italy
| | - Stefano Enrico
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital "San Luigi Gonzaga", Section of General Surgery, Orbassano, Turin, Italy
| | - Valter Martino
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital "San Luigi Gonzaga", Section of General Surgery, Orbassano, Turin, Italy
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Ferrarese A, Bindi M, Rivelli M, Solej M, Enrico S, Martino V. Self-gripping mesh versus fibrin glue fixation in laparoscopic inguinal hernia repair: a randomized prospective clinical trial in young and elderly patients. Open Med (Wars) 2016; 11:497-508. [PMID: 28352842 PMCID: PMC5329874 DOI: 10.1515/med-2016-0087] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 08/19/2016] [Indexed: 12/29/2022] Open
Abstract
Laparoscopic transabdominal preperitoneal inguinal hernia repair is a safe and effective technique. In this study we tested the hypothesis that self-gripping mesh used with the laparoscopic approach is comparable to polypropylene mesh in terms of perioperative complications, against a lower overall cost of the procedure. We carried out a prospective randomized trial comparing a group of 30 patients who underwent laparoscopic inguinal hernia repair with self-gripping mesh versus a group of 30 patients who received polypropylene mesh with fibrin glue fixation. There were no statistically significant differences between the two groups with regard to intraoperative variables, early or late intraoperative complications, chronic pain or recurrence. Self-gripping mesh in transabdominal hernia repair was found to be a valid alternative to polypropylene mesh in terms of complications, recurrence and postoperative pain. The cost analysis and comparability of outcomes support the preferential use of self-gripping mesh.
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Affiliation(s)
- Alessia Ferrarese
- University of Turin, Section of General Surgery, San Luigi Gonzaga Teaching Hospital, Regione Gonzole 10, 10043 Orbassano, Turin, Italy
| | - Marco Bindi
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital “San Luigi Gonzaga”, Section of General Surgery, Orbassano, Turin, Italy
| | - Matteo Rivelli
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital “San Luigi Gonzaga”, Section of General Surgery, Orbassano, Turin, Italy
| | - Mario Solej
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital “San Luigi Gonzaga”, Section of General Surgery, Orbassano, Turin, Italy
| | - Stefano Enrico
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital “San Luigi Gonzaga”, Section of General Surgery, Orbassano, Turin, Italy
| | - Valter Martino
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital “San Luigi Gonzaga”, Section of General Surgery, Orbassano, Turin, Italy
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Surace A, Ferrarese A, Gentile V, Bindi M, Cumbo J, Solej M, Enrico S, Martino V. Learning curve for endorectal ultrasound in young and elderly: lights and shades. Open Med (Wars) 2016; 11:418-425. [PMID: 28352830 PMCID: PMC5329861 DOI: 10.1515/med-2016-0074] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 09/20/2016] [Indexed: 01/04/2023] Open
Abstract
Aim of the study is to highlight difficulties faced by an inexperienced surgeon in approaching endorectal-ultrasound, trying to define when learning curve can be considered complete. A prospective analysis was conducted on endorectal-ultrasound performed for subperitoneal rectal adenocarcinoma staging in the period from January 2008 to July 2013, reported by a single surgeon of Department of Oncology, Section of General Surgery, "San Luigi Gonzaga" Teaching Hospital, Orbassano (Turin, Italy); the surgeon had no previous experience in endorectal-ultrasound. Fourty-six endorectal-ultrasounds were divided into two groups: early group (composed by 23 endorectal-ultrasounds, made from January 2008 to May 2009) and late group (composed by 23 endorectal-ultrasound, carried out from June 2009 to July 2013). In our experience, the importance of a learning curve is evident for T staging, but no statystical significance is reached for results deal with N stage. We can conclude that ultrasound evaluation of anorectal and perirectal tissues is technically challenging and requires a long learning curve. Our learning curve can not be closed down, at least for N parameter.
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Affiliation(s)
- Alessandra Surace
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital “San Luigi Gonzaga”, Section of General Surgery, Orbassano, Turin, Italy
| | - Alessia Ferrarese
- Department of Oncology, University of Turin, Section of General Surgery, San Luigi Gonzaga Teaching Hospital, Regione Gonzole 10, 10043 Orbassano, Turin, Italy
| | - Valentina Gentile
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital “San Luigi Gonzaga”, Section of General Surgery, Orbassano, Turin, Italy
| | - Marco Bindi
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital “San Luigi Gonzaga”, Section of General Surgery, Orbassano, Turin, Italy
| | - Jacopo Cumbo
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital “San Luigi Gonzaga”, Section of General Surgery, Orbassano, Turin, Italy
| | - Mario Solej
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital “San Luigi Gonzaga”, Section of General Surgery, Orbassano, Turin, Italy
| | - Stefano Enrico
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital “San Luigi Gonzaga”, Section of General Surgery, Orbassano, Turin, Italy
| | - Valter Martino
- University of Turin, Department of Oncology, School of Medicine, Teaching Hospital “San Luigi Gonzaga”, Section of General Surgery, Orbassano, Turin, Italy
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