{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T16:50:47Z","timestamp":1791910247246,"version":"4.3.4"},"reference-count":21,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T00:00:00Z","timestamp":1777420800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T00:00:00Z","timestamp":1777420800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100009055","name":"Canakkale Onsekiz Mart University","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100009055","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Hernia"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The transabdominal preperitoneal (TAPP) approach is a widely used minimally invasive technique for laparoscopic inguinal hernia repair. However, operative time and technical difficulty may vary depending on patient-related anatomical factors. This study evaluated the effect of the umbilicus\u2013symphysis pubis (USP) distance on operative time and investigated whether this superficial anatomical measurement could guide patient selection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this retrospective study, data from 767 patients who underwent TAPP repair at Gazi University Hospital between January 2015 and June 2022 were reviewed. After applying the exclusion criteria, 341 male patients were included. Of these, 272 had unilateral and 69 had bilateral inguinal hernia. The distance between the umbilicus and symphysis pubis was measured preoperatively in all patients. The relationship between USP distance and operative time was analyzed using the Python-based Maximally Selected Rank Statistics (MaxStat) method, and optimal cut-off values were determined.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The age range of the study group was 18.00\u201377.00 years, with a median age of 44.00 years. The USP distance ranged from 9.70 to 23.50\u00a0cm in unilateral cases and from 11.10 to 22.30\u00a0cm in bilateral cases. MaxStat analysis identified optimal cut-off values of 15\u00a0cm for unilateral and 16\u00a0cm for bilateral hernia cases. In unilateral cases, operative time was significantly longer in patients with a USP distance\u2009\u2264\u200915\u00a0cm (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Similarly, in bilateral cases, operative times were significantly longer when the USP distance was \u2264\u200916\u00a0cm (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>USP distance may serve as a simple and easily measurable anatomical parameter associated with surgical duration, particularly in unilateral TAPP repairs. As patients with a shorter USP distance were associated with longer operative times, this association warrants further prospective validation before USP distance can be considered a routine parameter in preoperative planning.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s10029-026-03687-7","type":"journal-article","created":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T07:16:41Z","timestamp":1777447001000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Association between umbilicus\u2013symphysis pubis distance and operative time in transabdominal preperitoneal (TAPP) inguinal hernia repair"],"prefix":"10.1007","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0189-5312","authenticated-orcid":false,"given":"Emre","family":"G\u00fcl\u00e7ek","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2418-2393","authenticated-orcid":false,"given":"Yunushan Furkan","family":"Aydo\u011fdu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6406-544X","authenticated-orcid":false,"given":"Safa","family":"\u00d6zayd\u0131n","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9141-4289","authenticated-orcid":false,"given":"\u00c7a\u011fr\u0131","family":"B\u00fcy\u00fckkasap","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,29]]},"reference":[{"issue":"1","key":"3687_CR1","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/s10029-017-1668-x","volume":"22","author":"HerniaSurge Group","year":"2018","unstructured":"HerniaSurge Group (2018) International guidelines for groin hernia management. Hernia 22(1):1\u2013165","journal-title":"Hernia"},{"issue":"5","key":"3687_CR2","doi-asserted-by":"publisher","first-page":"zrad080","DOI":"10.1093\/bjsopen\/zrad080","volume":"7","author":"C Stabilini","year":"2023","unstructured":"Stabilini C, van Veenendaal N, Aasvang E, Agresta F, Aufenacker T, Berrevoet F, Burgmans I, Chen D, de Beaux A, East B, Garcia-Alamino J, Henriksen N, K\u00f6ckerling F, Kukleta J, Loos M, Lopez-Cano M, Lorenz R, Miserez M, Montgomery A, Morales-Conde S, Oppong C, Pawlak M, Podda M, Reinpold W, Sanders D, Sartori A, Tran HM, Verdaguer M, Wiessner R, Yeboah M, Zwaans W, Simons M (2023) Update of the international HerniaSurge guidelines for groin hernia management. BJS Open 7(5):zrad080","journal-title":"BJS Open"},{"issue":"2","key":"3687_CR3","doi-asserted-by":"publisher","first-page":"151","DOI":"10.1007\/s10029-014-1236-6","volume":"18","author":"M Miserez","year":"2014","unstructured":"Miserez M, Peeters E, Aufenacker T, Bouillot JL, Campanelli G, Conze J, Fortelny R, Heikkinen T, Jorgensen LN, Kukleta J, Morales-Conde S, Nordin P, Schumpelick V, Smedberg S, Smietanski M, Weber G, Simons MP (2014) Update with level 1 studies of the European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia 18(2):151\u2013163","journal-title":"Hernia"},{"issue":"1","key":"3687_CR4","first-page":"e1","volume":"266","author":"J Daes","year":"2017","unstructured":"Daes J, Felix E (2017) Critical view of the myopectineal orifice. Annals ofSurgery 266(1):e1\u2013e2","journal-title":"Annals ofSurgery"},{"issue":"5","key":"3687_CR5","doi-asserted-by":"publisher","first-page":"511","DOI":"10.1097\/SLE.0000000000001220","volume":"33","author":"S Ar\u0131c\u0131","year":"2023","unstructured":"Ar\u0131c\u0131 S (2023) Impact of umbilicus\u2013symphysis pubis distance on technical difficulties in transabdominal preperitoneal hernia repair (TAPP). Surg Laparosc Endosc Percutan Tech 33(5):511\u2013514","journal-title":"Surg Laparosc Endosc Percutan Tech"},{"issue":"3","key":"3687_CR6","doi-asserted-by":"publisher","first-page":"e201400078","DOI":"10.4293\/JSLS.2014.00078","volume":"18","author":"A Meyer","year":"2014","unstructured":"Meyer A, Blanc P, Kassir R, Atger J (2014) Laparoscopic hernia: Umbilical\u2013pubis length versus technical difficulty. JSLS: J Soc Laparoendoscopic Surg 18(3):e201400078","journal-title":"JSLS: J Soc Laparoendoscopic Surg"},{"issue":"8","key":"3687_CR7","doi-asserted-by":"publisher","first-page":"738","DOI":"10.1080\/08941939.2018.1468944","volume":"32","author":"U Bracale","year":"2019","unstructured":"Bracale U, Merola G, Sciuto A, Cavallaro G, Andreuccetti J, Pignata G (2019) Achieving the learning curve in laparoscopic inguinal hernia repair by TAPP: A quality improvement study. J Invest Surg 32(8):738\u2013745","journal-title":"J Invest Surg"},{"issue":"3","key":"3687_CR8","doi-asserted-by":"publisher","first-page":"504","DOI":"10.1111\/bju.12197","volume":"113","author":"N Khan","year":"2014","unstructured":"Khan N, Abboudi H, Khan MS, Dasgupta P, Ahmed K (2014) Measuring the surgical learning curve. BJU Int 113(3):504\u2013508","journal-title":"BJU Int"},{"key":"3687_CR9","doi-asserted-by":"publisher","first-page":"2886","DOI":"10.1007\/s00464-013-2849-z","volume":"27","author":"U B\u00f6keler","year":"2013","unstructured":"B\u00f6keler U, Schwarz J, Bittner R et al (2013) Teaching and training in laparoscopic inguinal hernia repair (TAPP): Impact of the learning curve on patient outcome. Surg Endosc 27:2886\u20132893","journal-title":"Surg Endosc"},{"key":"3687_CR10","doi-asserted-by":"crossref","unstructured":"Brian R, Davis G, Park KM, Alseidi A (2022) Evolution of laparoscopic education and the laparoscopic learning curve: A review of the literature. Laparosc Surg 6:34","DOI":"10.21037\/ls-22-29"},{"issue":"2","key":"3687_CR11","first-page":"48","volume":"6","author":"S Maheshwari","year":"2021","unstructured":"Maheshwari S, Sharma BK, Misra MC (2021) Learning curve in laparoscopic inguinal hernia repair. J Mahatma Gandhi Univ Med Sci Technol 6(2):48\u201352","journal-title":"J Mahatma Gandhi Univ Med Sci Technol"},{"issue":"6","key":"3687_CR12","doi-asserted-by":"publisher","first-page":"666","DOI":"10.1097\/SLE.0000000000001111","volume":"32","author":"N Ichikawa","year":"2022","unstructured":"Ichikawa N, Homma S, Yoshida T, Emoto S, Imaizumi K, Matsui H, Tani M, Miyaoka Y, Taketomi A (2022) Interischial spine distance is a simple index of the narrow pelvis that can predict difficulty during laparoscopic low anterior resection. Surg Laparosc Endosc Percutan Tech 32(6):666\u2013672","journal-title":"Surg Laparosc Endosc Percutan Tech"},{"key":"3687_CR13","doi-asserted-by":"publisher","first-page":"434","DOI":"10.1007\/s00464-022-09530-1","volume":"37","author":"ACH Fung","year":"2023","unstructured":"Fung ACH, Chan IHY, Wong KKY (2023) Outcome and learning curvefor laparoscopic intracorporeal inguinal hernia repair in children. Surg Endosc 37:434\u2013442","journal-title":"Surg Endosc"},{"issue":"2","key":"3687_CR14","first-page":"238","volume":"94","author":"CH Nezhat","year":"1999","unstructured":"Nezhat CH, Nezhat F, Brill AI, Nezhat C (1999) Normal variations of abdominal and pelvic anatomy evaluated at laparoscopy. Obstet Gynecol 94(2):238\u2013242","journal-title":"Obstet Gynecol"},{"issue":"1","key":"3687_CR15","doi-asserted-by":"publisher","first-page":"207","DOI":"10.1186\/s12893-024-02495-z","volume":"24","author":"YF Aydo\u011fdu","year":"2024","unstructured":"Aydo\u011fdu YF, G\u00fcl\u00e7ek E, Koyuncuo\u011flu AC, B\u00fcy\u00fckkasap \u00c7, Dikmen K (2024) Minimally invasive approach in a rare emergency surgery, gallbladder perforation. BMC Surg 24(1):207. https:\/\/doi.org\/10.1186\/s12893-024-02495-z PMID: 38987756; PMCID: PMC11234621","journal-title":"BMC Surg"},{"key":"3687_CR16","doi-asserted-by":"crossref","unstructured":"Muavha DA, Ras L, Jeffery S (2019) Laparoscopic surgical anatomy for pelvic floor surgery. Best Pract Res Clin Obstet Gynaecol 54:89\u2013102","DOI":"10.1016\/j.bpobgyn.2018.11.005"},{"issue":"5","key":"3687_CR17","doi-asserted-by":"publisher","first-page":"334","DOI":"10.1097\/SLE.0b013e31822cf8bc","volume":"21","author":"JY Kim","year":"2011","unstructured":"Kim JY, Kim YW, Kim NK, Hur H, Lee K, Min BS, Cho HJ (2011) Pelvic anatomy as a factor in laparoscopic rectal surgery: A prospective study. Surg Laparosc Endosc Percutan Tech 21(5):334\u2013339","journal-title":"Surg Laparosc Endosc Percutan Tech"},{"key":"3687_CR18","doi-asserted-by":"publisher","first-page":"2453","DOI":"10.1007\/s00464-022-09760-3","volume":"37","author":"J Sivakumar","year":"2023","unstructured":"Sivakumar J, Chen Q, Hii MW et al (2023) Learning curve of laparoscopic inguinal hernia repair: Systematic review, meta-analysis, and meta-regression. Surg Endosc 37:2453\u20132475","journal-title":"Surg Endosc"},{"key":"3687_CR19","doi-asserted-by":"publisher","first-page":"573","DOI":"10.1007\/s00464-016-5001-z","volume":"31","author":"F K\u00f6ckerling","year":"2017","unstructured":"K\u00f6ckerling F, Bittner R, Kraft B et al (2017) Does surgeon volume matter in the outcome of endoscopic inguinal hernia repair? Surg Endosc 31:573\u2013585","journal-title":"Surg Endosc"},{"issue":"11 Suppl","key":"3687_CR20","doi-asserted-by":"publisher","first-page":"S21","DOI":"10.1016\/j.jmig.2025.09.110","volume":"32","author":"C Akesson","year":"2025","unstructured":"Akesson C, Mintz G, Sridhar S, Gubbels AC (2025) Precise port placement: An analytic review of lower quadrant anatomy. J Minim Invasive Gynecol 32(11 Suppl):S21","journal-title":"J Minim Invasive Gynecol"},{"issue":"12","key":"3687_CR21","doi-asserted-by":"publisher","first-page":"6643","DOI":"10.1007\/s00464-020-08165-4","volume":"35","author":"F Proietti","year":"2021","unstructured":"Proietti F, La Regina D, Pini R, Di Giuseppe M, Cianfarani A, Mongelli F (2021) Learning curve of robotic-assisted transabdominal preperitoneal repair (rTAPP) for inguinal hernias. Surg Endosc 35(12):6643\u20136649","journal-title":"Surg Endosc"}],"container-title":["Hernia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10029-026-03687-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s10029-026-03687-7","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10029-026-03687-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T22:54:57Z","timestamp":1781650497000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s10029-026-03687-7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,29]]},"references-count":21,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["3687"],"URL":"https:\/\/doi.org\/10.1007\/s10029-026-03687-7","relation":{},"ISSN":["1248-9204"],"issn-type":[{"value":"1248-9204","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,29]]},"assertion":[{"value":"2 March 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"8 April 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"29 April 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study was conducted in accordance with the principles of the Declaration of Helsinki after obtaining approval from the Gazi University Ethics Committee (24.11.2023-E.805489). And signed informed consent forms were obtained from all patients.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Human ethics & consent to participate"}},{"value":"All procedures performed in this study were by the ethical standards of the institutional and\/or national research committee and the 1964 Declaration of Helsinki and its subsequent amendments or similar ethical standards. No animal or human studies were performed by the authors for this article.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Animal and human rights statement"}},{"value":"The authors declare that they are responsible for the scientific content of the article, including study design, data collection, analysis and interpretation, writing, part or all of the outline, preparation and scientific review of the content, and approval of the final version of the article.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Scientific responsibility statement"}},{"value":"There are no conflicts of interest in connection with this paper.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"<!--Emphasis Type='Bold' removed-->Conflicts of interest"}}],"article-number":"189"}}