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

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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.

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Acknowledgments

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.

Disclosures

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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Authors and Affiliations

  1. Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montreal, QC, Canada

    Yo Kurashima, Liane S. Feldman, Pepa A. Kaneva, Gerald M. Fried, Chao Li & Melina C. Vassiliou

  2. Arnold and Blema Steinberg Medical Simulation Centre, Montreal, QC, Canada

    Yo Kurashima, Liane S. Feldman, Pepa A. Kaneva, Gerald M. Fried, Chao Li & Melina C. Vassiliou

  3. Department of Surgery, Jewish General Hospital, McGill University, Montreal, QC, Canada

    Simon Bergman

  4. Department of Surgery, Saint Mary’s Hospital, McGill University, Montreal, QC, Canada

    Sebastian V. Demyttenaere

  5. Department of Gastroenterological Surgery II, Hokkaido University Graduate School of Medicine, Sapporo, Japan

    Yo Kurashima

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  1. Yo Kurashima
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  2. Liane S. Feldman
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  3. Pepa A. Kaneva
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  6. Sebastian V. Demyttenaere
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  7. Chao Li
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  8. Melina C. Vassiliou
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Correspondence to Yo Kurashima.

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Kurashima, Y., Feldman, L.S., Kaneva, P.A. et al. Simulation-based training improves the operative performance of totally extraperitoneal (TEP) laparoscopic inguinal hernia repair: a prospective randomized controlled trial. Surg Endosc 28, 783–788 (2014). https://doi.org/10.1007/s00464-013-3241-8

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  • DOI: https://doi.org/10.1007/s00464-013-3241-8

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