The Efficacy of Patient Centered Outcomes in Determining the Effectiveness of Surgical Mentorship in Rural Saskatchewan

Special Article – Laparoscopic Surgery

Austin J Surg. 2018; 5(7): 1149.

The Efficacy of Patient Centered Outcomes in Determining the Effectiveness of Surgical Mentorship in Rural Saskatchewan

Pillay Y¹* and Abeygunawardena K²

¹Department of General Surgery, University of Saskatchewan, Canada

²University of Toronto, Canada

*Corresponding author: Pillay Y, Department of General Surgery, University of Saskatchewan, Prince Albert, SK, Canada

Received: August 23, 2018; Accepted: September 24, 2018; Published: October 01, 2018


Background: Advanced laparoscopic skills are difficult to obtain for practicing surgeons. This issue is exponentially more difficult for surgeons in rural practice. Surgical mentorship is one way in which this can be achieved.

Material and Methods: A surgical mentorship program was under taken by the author under the auspices of a senior surgeon at the same hospital he practices in. This was under taken to learn the Laparoscopic Transabdominal Pre - Peritoneal herniorrhaphy technique (TAPP). This involved supervision of the first twenty operative procedures. Once there was satisfaction with the technique the remaining surgical procedures were performed independently without supervision.

Over a four-year duration, fifty-nine procedures were performed by the first author. Data was assessed retrospectively with the use of an outcome questionnaire adapted from the EuroQol© questionnaire.

Results: A patient centered outcomes questionnaire was employed to determine the efficacy of the mentorship program. This was done through a retrospective audit of the first four years of this advanced technique. An established short quality of life questionnaire, the EuroQol© was used and adapted for laparoscopic hernia surgery 94 percent of patients would recommend the surgeon to other patients for this surgery. There were no hernia recurrences and three patients had inguinodynia, all of whom were managed conservatively

Discussion: The patient centered outcomes clearly demonstrate satisfaction with the surgical mentorship program. While this was a small study with insufficient follow up for long term post - operative complications, it does show the feasibility of patient centered outcomes in determining the effectiveness of surgical mentorship.

Keywords: Patient centered outcomes; Laparoscopic inguinal herniorrhaphy; Surgical mentorship


Enhanced laparoscopic skills are often difficult to obtain for surgeons in private practice and this difficulty is magnified in rural surgery. Given the paucity of general surgeons in rural practice as well as the large geographic area covered, the ability to enhance one`s laparoscopic skills is usually obtained at great financial and personal cost to the surgeon and often involves training at a center, a great distance from the surgeon`s hospital. An alternate way to acquire the requisite skill set is to learn from a senior surgeon who is performing the surgery at the same hospital or health region [1]. A surgical mentorship programmer was undertaken by the author under the auspices of a senior surgeon at the Victoria hospitain Prince Albert, Saskatchewan, Canada. This involved the learning of the laparoscopic Trans Abdominal Pre-Peritoneal Herniorrhaphy (TAPP) technique. A polypropylene mesh was used and inserted pre-peritoneally and covered by the peritoneal flaps that were raised laparoscopically.

The first twenty repairs were done under supervision of the surgical mentor who was present in the operating room (OR) as an observer. Prior to this the junior surgeon scrubbed in as a surgical assistant with the mentor surgeon to observe the procedure. This occurred for half a dozen procedures before the junior surgeon began performing the procedure under the surgial mentor`s supervision. Once there was satisfaction with the surgical technique, the remaining procedures were performed independently without the surgical mentor in the OR. The junior surgeon`s laparoscopic expertise extended to cholecystectomy and appendectomy prior toembarkingonthis mentorship programmer.

The mentorship process was facilitated by the OR already being setup for a TAPP approach, the technique employed by the surgical mentor. The OR staff had previouslybeen trained in this advanced technique which facilitated an easier transition for the junior surgeon in terms of the operative setup and surgical instrumentation. The surgical procedures were video recorded with informed consent from the patients. The videos were viewed post operatively by the surgical mentorwho reviewed the surgical technique employed. This helped to eliminate technical errors and reinforce appropriate surgical techniques, which werefurtherstrengthened by adherence to surgical first principles of the TAPP procedure.Historically, in determining the efficacy of previous mentorship programssurgeons have looked at surgical outcome parameters such as operating time, surgical complications and operative recovery time [2]. This usually addresses the surgeon`s outlook on surgery and rarely does it take into consideration, patient centered outcomes.

Material and Methods

Ethics approval was obtained from the Prince Albert Parkland Health Region for this study. This retrospective audit looked at the first 59 laparoscopic inguinal hernia repairs that were performed. This occurred over four years from 2011 to 2015. Emphasis was placed on the duration of four years, hence the odd number of 59 patients. A questionnaire on patient outcomes was used and a telephonic interview conducted. This was performed by the medical office assistant and the juniorsurgeon. Data collection took approximately nine months. This was quite a laborious process given the migrant nature of the population in northern Saskatchewan and the lack of up to date contact information on the patient cohort. Data collection often involved contacting the patient`s family or friends and leaving messages for them to contact the surgeon`s office. Messages were also left with referring family physicians to ask the patient to contact us when they arrived for a medical examination. Despite exhaustive attempts there were eight patients who could not be contacted (Table 1). The surgical questionnaire was adapted from an established short quality of life Questionnaire (Qol), the EuroQol© questionnaire [3]. The EuroQol© is a standardized instrument for use as a measure of health outcomes. It is applicable to a wide range of health conditions and treatments, and has been validated in many languages (Figures 1-5). This was a standard patient outcome questionnaire adapted for hernia surgery. The adaptation was performed to keep the questions limited to the basic issues of inguinal herniorrhaphy while determining patient demographics as well.