Surgical Endoscopy

, Volume 32, Issue 5, pp 2480–2487 | Cite as

Educational system based on the TAPP checklist improves the performance of novices: a multicenter randomized trial

  • Saseem Poudel
  • Yo KurashimaEmail author
  • Kimitaka Tanaka
  • Hiroshi Kawase
  • Yoichi M. Ito
  • Fumitaka Nakamura
  • Toshiaki Shichinohe
  • Satoshi Hirano



Despite recent developments in surgical education, obstacles including inadequate budget, limited human resources, and a scarcity of time have limited its widespread adoption. To provide systematic training for laparoscopic inguinal hernia repair, we had previously developed and validated a checklist to evaluate the recorded performance of transabdominal preperitoneal (TAPP) repair. We had also developed an educational system that included didactic materials based on the TAPP checklist and incorporated remote evaluation and feedback system. The aim of this study was to evaluate the educational impact of the TAPP education system on novice surgeons.


Residents and surgeons from participating hospitals, who had performed 0 or 1 TAPP procedure, were randomly assigned to the intervention group (IG), who trained using this new educational tool, and the control group (CG), who trained using the conventional system. Their surgical videos were rated by blinded raters. All participants performed their first case prior to randomization. The primary outcome was improvement of TAPP checklist score from the first to the third case.


Eighteen participants from 9 institutes were recruited for this study. Seven participants in the IG and 5 participants in the CG were included in the final analysis. The participants in the IG demonstrated significant improvement in their TAPP performance (p = 0.044) from their first case to their third case, whereas their counterparts in the CG failed to make any significant progress during the same period (p = 0.581).


The new TAPP educational system was effective in improving the TAPP performance of novice surgeons.


Surgical education Laparoscopic inguinal hernia repair Transabdominal preperitoneal (TAPP) repair Assessment and feedback Remote education 



The authors would like to thank all the surgeons from the participating institutes, for helping us with this study.

Compliance with ethical standards


Yo Kurashima is a consultant at Ethicon and Medicon. Saseem Poudel, Kimitaka Tanaka, Hiroshi Kawase, Yoichi M Ito, Fumitaka Nakamura, Toshiaki Shichinohe, and Satoshi Hirano have no conflicts of interest or financial ties to disclose.


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Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Saseem Poudel
    • 1
  • Yo Kurashima
    • 1
    • 2
    Email author
  • Kimitaka Tanaka
    • 1
  • Hiroshi Kawase
    • 1
  • Yoichi M. Ito
    • 3
  • Fumitaka Nakamura
    • 4
  • Toshiaki Shichinohe
    • 1
  • Satoshi Hirano
    • 1
  1. 1.Department of Gastroenterological Surgery IIHokkaido University Graduate School of MedicineSapporoJapan
  2. 2.Clinical Simulation CenterHokkaido UniversitySapporoJapan
  3. 3.Department of BiostatisticsHokkaido UniversitySapporoJapan
  4. 4.Department of SurgeryTeine Keijinkai HospitalSapporoJapan

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