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Minimally Invasive Surgery
Volume 2014, Article ID 528517, 5 pages
Clinical Study

A New Proposal for Learning Curve of TEP Inguinal Hernia Repair: Ability to Complete Operation Endoscopically as a First Phase of Learning Curve

1Department of General Surgery, Faculty of Medicine, Bezmialem Vakif University, Vatan Street, Fatih, 34093 Istanbul, Turkey
2Department of General Surgery, Umraniye Education and Research Hospital, Umraniye, 34766 Istanbul, Turkey
3Department of General Surgery, Lutfi Kirdar Kartal Education and Research Hospital, Kartal, 34890 Istanbul, Turkey
4Department of General Surgery, Faculty of Medicine, Istanbul Medeniyet University, Kadikoy, 34722 Istanbul, Turkey

Received 30 October 2013; Accepted 4 April 2014; Published 23 April 2014

Academic Editor: Steve Ramcharitar

Copyright © 2014 Mustafa Hasbahceci et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Background. The exact nature of learning curve of totally extraperitoneal inguinal hernia and the number required to master this technique remain controversial. Patients and Methods. We present a retrospective review of a single surgeon experience on patients who underwent totally extraperitoneal inguinal hernia repair. Results. There were 42 hernias (22 left- and 20 right-sided) in 39 patients with a mean age of years. Indirect, direct, and combined hernias were present in 18, 12, and 12 cases, respectively. The mean operative time was minutes. Peritoneal injury occurred in 9 cases (21.4%). Conversion to open surgery was necessitated in 7 cases (16.7%). After grouping of all patients into two groups as cases between 1–21 and 22–42, it was seen that the majority of peritoneal injuries (7 out of 9, 77.8%, ) and all conversions () occurred in the first 21 cases. Conclusions. Learning curve of totally extraperitoneal inguinal hernia repair can be divided into two consequent steps: immediate and late. At least 20 operations are required for gaining anatomical knowledge and surgical pitfalls based on the ability to perform this operation without conversion during immediate phase.