Laparoscopic inguinal hernia repair: impact of surgical time in the learning curve.

PURPOSE: One of the procedures that has become very popular thanks to the advantages of minimally invasive approach is the laparoscopic treatment of inguinocrural hernias. As a disadvantage, it would imply a longer learning curve when compared to the conventional approach. There is no consensus about the number of procedures required to dominate this surgical technique, since according to bibliography it ranges from 20 to 240. METHODS: We analyzed and compared the progress of 18 third year surgical residents while they were introducing into laparoscopic transabdominal preperitoneal inguinal hernioplasties between June 2013 and May 2018. RESULTS: Between June 2013 and May 2018, 1282 laparoscopic inguinal hernioplasties were performed (71 procedures per resident). Mean surgical time was for unilateral: 62.13 min (SD ± 15.54; range 30-105 min) for the first third (Q1) vs 54.61 min (SD ± 15.38; range 30-100 min) for the last third (Q3): p < 0.0001. For bilateral were: 92.59 min (SD ± 21.89; range 50-160 min) for Q1 vs 84.48 min (SD ± 20.52; range 30-130 min) for Q3: p < 0.05. Accepting an alpha error of 5% and considering an association power of 80%, there would be needed 61 cases per surgeon to achieve a significant reduction in surgical time. CONCLUSION: In a center with high-volume in TAPP and under a supervised training program, it is feasible to achieve a reduction in surgical time. Randomized studies with a larger number of cases are necessary to confirm this finding and draw more robust and objective conclusions.

Intradiaphragmatic bronchogenic cyst: report of a rare new case.

Bronchogenic cysts (BCs) are congenital abnormalities commonly found within the mediastinum. Diaphragmatic location is extremely rare. We present a woman in her 60s with an asymptomatic intradiaphragmatic BC. The patient underwent complete surgical resection with primary closure of the left hemidiaphragm. BCs should remain a differential diagnosis of any soft-tissue mass in the region of the diaphragm. Complete surgical resection is recommended even in asymptomatic patients to avoid complications such as infection, rupture, bleeding or malignant transformation.