Page 95 - International guidelines for groin hernia management

Hernia

2
Groin Hernia Management Globally patient outcomes. Technical competence is the ability to
achieve a mastery level outcome in three consecutive
28. Inguinal hernia surgery in low resource
attempts at a technical skill, where mastery level is cal-
environments
culated as the mean scores of several surgical experts
Research, General Practitioners and Patient’s Perspectives (surgeons with excellent patient outcomes) in the same
3
skill. The learning curve is defined as the time and effort
29. Questions for research
necessary to achieve proficiency.
30. Summary for general practitioners
Assessing proficiency by objective standardized tools is
31. Groin hernias: a patient’s perspective 4, 5
possible but resource intense, thus the number of pro-
cedures performed, years spent in training, operative time
and complication rates continue to be proxies for profi-
ciency and metrics for learning curve progress.
Chapter 22 Globally, options for training are diverse and evolving.
Most surgical training programs include time for super-
vised performance of IH repairs. HerniaSurge considers
Training and the learning curve ‘‘supervision’’ as the presence of a trained expert in the
operating room. Training components are both cognitive
J. Bingener, R. Simmermacher, D. Lomanto and W. and technical: groin area anatomy, procedural steps,
Reinpold intraoperative decision making and manual dexterity.
These components should be safely acquired before inde-
General introduction pendent practice occurs.
This chapter’s goal is to review evidence and provide This chapter will not address the learning curve for
guidance for two questions: pioneering a new technique or technology. Recommenda-
tions to safely guide these developments can be found in
What are the learning curves of the different 6
the IDEAL framework for surgical innovation. As a
techniques?
general rule, patient outcomes should be the same or better
What are the best methods to teach groin hernia
than for existing techniques once the novel approach is
repair?
fully developed.
Depending on circumstances, training to perform IH KQ22.a What is the learning curve for open inguinal
repair has different competency goals. In rural or low hernia repair, anterior approach?
resource settings, training may be focused on the basic KQ22.b What is the learning curve for open inguinal
ability to perform any inguinal repair for patients with hernia repair, posterior approach?
significant symptoms without causing mortality or serious KQ22.c What is the learning curve for laparoscopic
1
morbidity (see also Chapter 28). inguinal hernia repair, TEP?
The advent of laparoscopic techniques directed attention KQ22.d What is the learning curve for laparoscopic
to the technical learning curve of surgical procedures. inguinal hernia repair, TAPP?
Learning curricula initially focused on the number of rep- KQ22.e What are the best methods to teach open hernia
etitions needed to achieve outcomes similar to experts. It repair?
soon became clear that skills proficiency or competence, KQ22.f What are the best methods to teach laparoscopic
rather than number of repetitions, correlated to improved inguinal hernia repair?

123