{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,9]],"date-time":"2026-11-09T08:22:46Z","timestamp":1794212566554,"version":"4.8.0"},"reference-count":17,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T00:00:00Z","timestamp":1778630400000},"content-version":"vor","delay-in-days":132,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Asian J Endoscop Surgery"],"published-print":{"date-parts":[[2026,1]]},"abstract":"ABSTRACT<\/jats:title>\n \n Introduction<\/jats:title>\n Single\u2010incision laparoscopic totally extraperitoneal inguinal hernia repair (SILS\u2010TEP) provides excellent cosmetic outcomes but is technically more demanding than conventional multi\u2010port TEP. Most studies on learning curves focus on single\u2010surgeon experiences. This study aimed to evaluate the collective learning curves of SILS\u2010TEP among multiple experienced gastrointestinal surgeons using cumulative sum (CUSUM) analysis.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n We retrospectively reviewed 1500 consecutive unilateral SILS\u2010TEP procedures performed by six surgeons (250 cases per surgeon) between May 2021 and December 2025. All surgeons were proficient in general laparoscopic surgery (10\u201333\u2009years of experience) but were novices in SILS\u2010TEP. Learning curves were analyzed based on operative time using CUSUM analysis. The proficiency threshold was identified, and perioperative outcomes were compared between the learning phase (Phase 1) and the experienced phase (Phase 2).<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n CUSUM analysis identified a mean proficiency threshold of 95 cases (range: 63\u2013147 cases) across all surgeons. The median operative time significantly decreased from 81\u2009min in Phase 1 to 66\u2009min in Phase 2 (\n p<\/jats:italic>\n \u2009<\u20090.0001). While recurrence (0.067%) and overall complication (1.67%) rates remained stable, the incidence of peritoneal injury was significantly lower in Phase 2 compared to Phase 1 (\n p<\/jats:italic>\n \u2009=\u20090.0004).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n The learning curve for SILS\u2010TEP stabilized at an institutional mean of 95 cases under a structured mentoring program. However, individual proficiency thresholds varied notably, ranging from 63 to 147 cases. These findings suggest that while 95 cases serve as a useful institutional benchmark, training programs should remain flexible to accommodate individual surgical learning paces to ensure maximum safety.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/ases.70308","type":"journal-article","created":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T00:41:04Z","timestamp":1778719264000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Learning Curve Analysis of Single\u2010Incision Laparoscopic Totally Extraperitoneal Inguinal Hernia Repair (\n SILS<\/scp>\n \u2010\n TEP<\/scp>\n ) Among Multiple Surgeons: A Large\u2010Scale\n CUSUM<\/scp>\n Evaluation"],"prefix":"10.1111","volume":"19","author":[{"given":"Yosuke","family":"Kamada","sequence":"first","affiliation":[{"name":"Kyoto Gi Surgical Clinic Kyoto Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kumiko","family":"Akashi","sequence":"additional","affiliation":[{"name":"Kyoto Gi Surgical Clinic Kyoto Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nobuhito","family":"Kubota","sequence":"additional","affiliation":[{"name":"Hanshin Gi Surgical Clinic Nishinomiya Hyogo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akira","family":"Endo","sequence":"additional","affiliation":[{"name":"Kyoto Gi Surgical Clinic Kyoto Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshihiro","family":"Ikeda","sequence":"additional","affiliation":[{"name":"Okayama Gi Surgical Clinic Okayama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,13]]},"reference":[{"key":"e_1_2_15_2_1","article-title":"A New Proposal for Learning Curve of TEP Inguinal Hernia Repair: Ability to Complete Operation Endoscopically as a First Phase of Learning Curve","volume":"2014","author":"Hasabahceci M.","year":"2014","journal-title":"Minimally Invasive Surgery"},{"key":"e_1_2_15_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/ases.12639"},{"key":"e_1_2_15_4_1","first-page":"720","article-title":"Crucial Points in Phases of Totally Extraperitoneal (TEP) Hernia Repair. Learning Curve Analysis","volume":"92","author":"Eyvaz K.","year":"2021","journal-title":"Annali Italiani di Chirurgia"},{"key":"e_1_2_15_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10029-020-02228-0"},{"key":"e_1_2_15_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12262-015-1341-5"},{"key":"e_1_2_15_7_1","doi-asserted-by":"publisher","DOI":"10.1503\/cjs.019610"},{"key":"e_1_2_15_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-001-8298-0"},{"key":"e_1_2_15_9_1","doi-asserted-by":"publisher","DOI":"10.4174\/jkss.2012.83.2.92"},{"key":"e_1_2_15_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jss.2016.06.041"},{"key":"e_1_2_15_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-017-5426-z"},{"key":"e_1_2_15_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-025-11729-x"},{"key":"e_1_2_15_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-022-09760-3"},{"key":"e_1_2_15_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/ases.12744"},{"key":"e_1_2_15_15_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10029-017-1668-x"},{"key":"e_1_2_15_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10029-014-1236-6"},{"key":"e_1_2_15_17_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00464-012-2512-0"},{"key":"e_1_2_15_18_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10029-021-02431-7"}],"container-title":["Asian Journal of Endoscopic Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ases.70308","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/ases.70308","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ases.70308","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,11,9]],"date-time":"2026-11-09T07:39:58Z","timestamp":1794209998000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/ases.70308"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":17,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1111\/ases.70308"],"URL":"https:\/\/doi.org\/10.1111\/ases.70308","archive":["Portico"],"relation":{},"ISSN":["1758-5902","1758-5910"],"issn-type":[{"value":"1758-5902","type":"print"},{"value":"1758-5910","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]},"assertion":[{"value":"2026-02-23","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-04","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-05-13","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70308"}}