The learning curve of laparoscopic enhanced-view totally extraperitoneal rives stoppa (eTEP-RS) for ventral hernia repair: A cumulative sum (CUSUM) analysis.

Abstract

<h4>Purpose</h4>The enhanced view totally extraperitoneal (eTEP) approach is gaining popularity in the context of abdominal wall hernia repair; thus, the learning curve is an important consideration. The aim of this study was to analyze the laparoscopic eTEP-RS learning curve on the basis of the operative times of a single surgeon.<h4>Methods</h4>Data from 93 patients who underwent elective eTEP ventral hernia repair between October 2018 and May 2023 performed by a single surgeon were retrospectively analyzed. Patients who underwent simultaneous eTEP-TAR or inguinal hernia repairs were excluded to decrease the number of outliers with respect to the operative time. The 63 eTEP-RS cases were evaluated via cumulative sum (CUSUM) analysis on the basis of operative times to have separate learning phases.<h4>Results</h4>The cohort was divided into three chronological groups representing the learning phases held from the CUSUM analysis: Group 1 (G1, 1 to 10), Group 2 (11-41), and Group 3 (42-63). The median and interquartile range (IQR) for each group were as follows: G1, 272.5 min (256.25-291.25); G2, 180 min (160-190); and G3, 110 min (100-135). The differences in operative times among the groups were significant (G1-G2, p < 0.0001; G2-G3, p < 0.0001; G1-G3, p < 0.0001). Three intraoperative complications occurred in the early phases (G1 and G2), necessitating conversion to other techniques. The early postoperative pain scores during daily activities were higher in G1 and G2 than in G3 (G1 vs. G3, p = 0.01; G2 vs. G3, p = 0.02). The hospital length of stay (LOS) decreased as the phases progressed.<h4>Conclusions</h4>CUSUM analysis revealed a significant decrease in operative time following the completion of the tenth and 41st cases of consecutive eTEP-RS operations. Further research is essential to deepen our understanding of the learning curve of eTEP repairs in the future.