Surgical Endoscopy

, Volume 28, Issue 3, pp 783–788

Simulation-based training improves the operative performance of totally extraperitoneal (TEP) laparoscopic inguinal hernia repair: a prospective randomized controlled trial

  • Yo Kurashima
  • Liane S. Feldman
  • Pepa A. Kaneva
  • Gerald M. Fried
  • Simon Bergman
  • Sebastian V. Demyttenaere
  • Chao Li
  • Melina C. Vassiliou
Article

Abstract

Background

Laparoscopic surgery has an important role to play in the care of patients with inguinal hernias, but the procedure is difficult to learn. This study aimed to assess whether training to proficiency using a novel laparoscopic inguinal hernia repair (LIHR) simulation curriculum improved operating room (OR) performance.

Methods

For this study, 17 surgical residents [postgraduate years (PGYs) 2–5] participated in a didactic LIHR course and then were randomized to a training (T) or a control (C, standard residency) group. Performance of totally extraperitoneal (TEP) LIHR in the OR at baseline and after the study was measured using the Global Operative Assessment of Laparoscopic Skills–Groin Hernia (GOALS-GH).

Results

Of the 17 residents, 14 (5 T and 9 C) completed their final evaluations. The two groups showed no differences in terms of LIHR experience. The baseline GOALS-GH scores in the OR were similar (T 14.8; range 12.8–16.8 vs. C 13.6; range 12.3–14.8; P = 0.20). The mean number of training sessions needed to achieve proficiency was 4.8 (range 4.4–5.2), and the mean total training time was 109 min (range 61.9–149.1 min). After training, OR performance improved in the T group by 3.4 points (range 2.0–4.8 points; P = 0.002), whereas no significant change was seen in the C group [1.2; (range −1.1 to 3.6; P = 0.27)]. The final total GOALS-GH scores showed a trend toward better performance in the T group than in the C group [18.2; (range 14.9–21.5) vs. 14.8; (range 12.4–17.1); P = 0.06).

Conclusions

This study demonstrated the skills required for transfer of LIHR to the OR using a low-cost procedure-specific simulator. Residents who trained to proficiency on the McGill Laparoscopic Inguinal Hernia Simulator (MLIHS) showed greater skill improvement than their colleagues who did not. These results provide evidence supporting the use of simulation to teach and assess LIHR.

Keywords

Inguinal hernia Simulation training Laparoscopy 

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Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Yo Kurashima
    • 1
    • 2
    • 5
  • Liane S. Feldman
    • 1
    • 2
  • Pepa A. Kaneva
    • 1
    • 2
  • Gerald M. Fried
    • 1
    • 2
  • Simon Bergman
    • 3
  • Sebastian V. Demyttenaere
    • 4
  • Chao Li
    • 1
    • 2
  • Melina C. Vassiliou
    • 1
    • 2
  1. 1.Steinberg-Bernstein Centre for Minimally Invasive Surgery and InnovationMcGill UniversityMontrealCanada
  2. 2.Arnold and Blema Steinberg Medical Simulation CentreMontrealCanada
  3. 3.Department of Surgery, Jewish General HospitalMcGill UniversityMontrealCanada
  4. 4.Department of Surgery, Saint Mary’s HospitalMcGill UniversityMontrealCanada
  5. 5.Department of Gastroenterological Surgery IIHokkaido University Graduate School of MedicineSapporoJapan

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