Does a One-Day Course Influence Surgeon Adoption of Laparoscopic Ventral Herniorrhaphy?

Background

New laparoscopic techniques introduced after residency have created a new teaching paradigm focused on animate courses and preceptor instruction. The aim of this study was to test the effectiveness of animate course instruction in teaching laparoscopic ventral hernia repair (LVHR), its success in relationship to the course participants’ previous minimally invasive surgery experience, and the role of preceptors in adapting these techniques.

Methods

Surgeons participating in a one-day LVHR course (lectures/animal laboratory) at the Carolinas Medical Center were surveyed concerning professional demographics, prior laparoscopic experience, and their performance of LVHR before and after the encounter. Standard statistics were used to determine significance (P < 0.05).

Results

Of the 234 surgeons attending a LVHR course between 1999 and 2004, 171 (73%) answered the survey. Mean follow-up after the course was 427 days (range: 34–1202 d). Mean age was 45.9 years (range: 28–67 y). Mean time since residency was 14.4 years (range: 0.5–37 y), and 106 (62%) had learned at least basic laparoscopy in residency. One hundred twenty-six (73.7%) were in private practice. Since the course, 122 (71.3%) had performed a LVHR. They had performed a total of 2049 LVHRs (mean: 16.5; range: 1–102) compared with 1098 open herniorrhaphies (mean: 9; range: 1–23). There was no difference between those performing and not performing LVHR or the number executed with respect to practice type (P = 0.67), age (P = 0.47), years in practice (P = 0.19), or laparoscopic experience in residency (P = 0.42). Fifty-four (32%) surgeons had been precepted, and all have since performed LVHR. Surgeons with advanced laparoscopic experience were more likely to perform LVHR compared with those with only laparoscopic cholecystectomy experience (87% versus 33%, P = 0.02). Indeed, of those with only laparoscopic cholecystectomy experience who performed LVHR, 80% were precepted. In the subset of surgeons who had not yet performed LVHR, 28 intended to start, 17 requested assistance, and 4 planned not to begin.

Conclusions

A one-day course impacts surgeon practice patterns despite age or type of practice. Surgeons with advanced laparoscopic skills are more likely to perform LVHR. Most with limited experience will begin after working with a preceptor. Didactic instruction and a precepted experience may determine the future performance of advanced laparoscopy.

Key Words: ventral hernia repair, teaching, laparoscopy, laparoscopic ventral hernia repair