title: The learning curve for laparoscopic totally extraperitoneal herniorrhaphy by moving average.
abstract: OBJECTIVE
  Laparoscopic totally extraperitoneal (TEP) herniorrhaphy has been recognized as a treatment option for inguinal hernia. The objective of this study was to clarify the learning curve for laparoscopic TEP herniorrhaphy using the moving average method.
  
  
  METHODS
  A total of 90 patients underwent laparoscopic TEP herniorrhaphy by a single surgeon between March 2009 and March 2011. We analyzed medical records including the demographic data, operating time, hospital stay, and postoperative complications.
  
  
  RESULTS
  The mean operating time of the initial 30 cases (learning period group) was 66.3 minutes. After the initial 30 cases were performed, the time decreased to 52.8 minutes in the later 60 cases (experienced period group, P = 0.015). This represents the operating time becoming stabilized and then decreasing as the number of performed cases accumulates. Hospital stay was shorter and frequency of pain control, and complication rate were lower in the experienced period, however, there was no statistical significance.
  
  
  CONCLUSIONS
  We suggest that number of patients needed for the learning curve for laparoscopic TEP herniorrhaphy should be 30 cases. The operating time for laparoscopic TEP herniorrhaphy stabilizes after 40 cases in moving average analysis.
authors.affiliation: Department of Surgery, Konyang University College of Medicine, Daejeon, Korea.
authors.forename: Jong Won
authors.initials: JW
authors.lastname: Lim
authors.forename: Jin Yong
authors.initials: JY
authors.lastname: Lee
authors.forename: Sang Eok
authors.initials: SE
authors.lastname: Lee
authors.forename: Ju Ik
authors.initials: JI
authors.lastname: Moon
authors.forename: Yu Mi
authors.initials: YM
authors.lastname: Ra
authors.forename: In Seok
authors.initials: IS
authors.lastname: Choi
authors.forename: Won Jun
authors.initials: WJ
authors.lastname: Choi
authors.forename: Dae Sung
authors.initials: DS
authors.lastname: Yoon
authors.forename: Hyun Sik
authors.initials: HS
authors.lastname: Min