Surgical Endoscopy

, Volume 28, Issue 3, pp 783–788 | Cite as

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



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.


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).


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).


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.


Inguinal hernia Simulation training Laparoscopy 



The authors thank the McGill general surgery residents for their participation in this study. We could not have completed the study without their diligence and support.


The salary of Yo Kurashima was funded by an unrestricted Covidien grant during the time this research was conducted, but this is not believed to have influenced the research in any way. Liane S. Feldman is a consultant for Covidien and had a centre of excellence Grant from Covidien as well as an investigator-initiated research grant from Ethicon. Pepa Kaneva had a Covidien unrestricted grant to fund research. Gerald M. Fried had an Covidien unrestricted grant to fund research, and his son works for CAE Healthcare. Melina C. Vassiliou is a Covidien consultant and had an unrestricted Grant to fund research. Simon Bergman, Sebastian V. Demyttenaere, and Chao Li have no conflicts of interest or financial ties to disclose.


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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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