American Surgical Association

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Benjamin Zendejas, MD*, David A Cook, MD*, Juliane Bingener, MD*, Marianne Huebner, MD*, William F Dunn, MD*, Michael G Sarr, MD, David R Farley, MD*
Mayo Clinic, Rochester, MN

PURPOSE: To evaluate the effectiveness of a mastery learning, simulation-based curriculum for laparoscopic totally extraperitoneal (TEP) inguinal herniorraphy.
METHODS: After performing a baseline TEP in the OR, general surgery residents were randomized to mastery learning (ML) or standard practice (SP), and then re-assessed during subsequent TEPs. The ML curriculum involved Web-based cognitive learning modules followed by training on a TEP simulator until expert performance was achieved. Outcomes of operative time, performance ratings (GOALS), and patient outcomes adjusted for staff, resident participation, repair difficulty, and PGY level were compared between groups with mixed effects-ANOVA and generalized linear models.
RESULTS: Fifty residents (PGY1-5) performed 219 TEP repairs on 146 patients. Baseline time, performance, and demographics were similar between groups. To achieve mastery, ML-trained residents (n=26) required a mean of 16 (range 7-27) simulated repairs. Subsequently, TEPs performed by ML residents were faster than those performed by SP residents (adjusted mean [SEM], 35 [2] vs 48 [2] min; difference -12.68 min, 95%CI -17.95, -7.4, p<0.002). Operative performance ratings (scale 6-30) were better for ML residents (22.3 [0.7]) than for SP (18.6 [0.7]; p<0.001).Intraoperative complications (peritoneal tear, procedure conversion), post-operative complications (urinary retention, seroma), and overnight stay were more likely in the SP group (Odds Ratios 7.24, 5.7, and 2.73, respectively; p<0.03).
CONCLUSION: Simulation-based training with principles of mastery learning shortened operative time, improved trainee performance, and decreased the frequency of intra- and postoperative complications and overnight stay following laparoscopic TEP inguinal herniorraphy.


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