| | Theme | Examples (citations) |
| | Instruction of others | | | Experience | With regard to the trainees - if they have already endoscopic procedure or endoscopic experience or if they have an experience in the preperitoneal space they learn much easier because they know this anatomy.
The learning curve is none if you know how to perform a good inguinal hernia, anatomical dissection, and the technique, you can learn it very fast
We thought we understood it (…), but when we saw it the next day it was completely different from what they explained to us the night before. Yet we were all reasonable experienced in hernia surgery.
So there is a failure here to grasp the technique in many cases. If you don’t get it right what they say, then people will do it wrong. | | Patient selection | For the training procedure you should focus on – what is the best (type of patient) to start, it is important, because if you have a very tricky case at the beginning you will stop doing this (Onstep). | | Tailored teaching | There is a difference (between experienced and inexperienced trainees) if you are just a trainee (…) it is a step by step program.
The learning curve is none if you know how to perform a good inguinal hernia, anatomical dissection, and the technique, you can learn it very fast, but we have 16 trainees now in the department and many of them are good surgeons in performing ONSTEP technique, so it depends totally on the personal oriented technique. |
| | Comfort | I think you must do everything, so that the trainee or the surgeon you have in your operating room, is feeling comfortable, otherwise anything that you will do won’t help or will not succeed – he must feel comfortable during all the training and teaching.
If I go to another place, they were happier, because they were using their own anaesthetist, they had their own theatre staff, their own senior staff - so it made me slightly more stressed – but they learned more because they were in their own comfort zone.
Start with a simple case and when you feel comfortable – then you will stay on to the technique, otherwise you will leave it. |
| | Concerns/fear | The fear for me was the vessels – that was the major fear and that what’s everybody ask or are looking for when doing it, but if you overpass this fear I think that it is very easy and very comfortable to put your mesh on the hernia.
It is very important that you don’t destroy the reputation of ONSTEP in the beginning by teaching it the wrong way.
They never do that (perform the technique un supervised) because that would ruin the technique and perhaps the reputation, not only of the technique but my reputation also. |
| | Anatomy | With regard to the trainees - if they have already endoscopic procedure or endoscopic experience or if they have an experience in the preperitoneal space they learn much easier because they know this anatomy. Of course they normally are very surprised of the small incision and to look inside the preperitoneal space and we show them also to look inside, to look for the Cooper ligament, the cord and anything else, so they learn very fast, if they have the experience.
(…) they are afraid to make some damage to the vessels, maybe because the anatomy of this part is not really clear to all surgeons.
So, I think that one of the biggest problems is the anatomy. It has always been the anatomy and it still is. |
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