Abstract
Purpose
The anatomy of the inguinal region is notoriously challenging to master. We sought to teach open inguinal hernia (OIH) and totally extraperitoneal (TEP) anatomy with simulation models among general surgery (GS) interns.
Methods
Low-fidelity OIH and TEP models were constructed out of cardboard, plastic bins, fabric, and yarn. GS interns (n = 30) participated in a 3-h hernia session including a pretest, anatomy lecture, simulated OIH and TEP hernia repair, and posttest. Pre- and posttest scores were based on a difficult 30-point exam which included didactic questions (10 points), drawing relevant TEP (10 points), and OIH (10 points) anatomy. Participants were surveyed following the session.
Results
Median pretest scores were 13 % (range 0–60 %). Median posttest scores improved to 47 % (range 20–93 %, p < 0.001). Median number of structures drawn in the TEP image improved from 2 (range 0–14) to 11 (range 1–21, p < 0.001). Median number of structures drawn in the OIH image improved from 3 (range 0–15) to 7 (range 1–19, p < 0.001). 67 % (12/18) demonstrated improvement in knowledge of abdominal wall layers. 23 % (7/30) knew the triangles of pain/doom on the pretest vs. 77 % (23/30) on the posttest. Mean Likert scores favored session enjoyability (4.5), not a waste of training time (4.4), and improved understanding of OIH and TEP anatomy (4.4, 4.2).
Conclusions
Low-fidelity simulators can be used to teach and assess knowledge of TEP and OIH anatomy. While enjoyable and useful, one 3-h session does not create master hernia surgeons or expert anatomists out of novice trainees.
Similar content being viewed by others
References
Phillips EH, Rosenthal R, Fallas M, Carroll B, Arregui M, Corbitt J, Fitzgibbons R, Seid A, Schultz L, Toy F et al (1995) Reasons for early recurrence following laparoscopic hernioplasty. Surg Endosc 9:140–144 (discussion 144–145)
Burcharth J, Andresen K, Pommergaard HC, Bisgaard T, Rosenberg J (2014) Recurrence patterns of direct and indirect inguinal hernias in a nationwide population in Denmark. Surgery 155:173–177
Grosfeld JL, Minnick K, Shedd F, West KW, Rescorla FJ, Vane DW (1991) Inguinal hernia in children: factors affecting recurrence in 62 cases. J Pediatr Surg 26:283–287
Wijsmuller AR, van Veen RN, Bosch JL, Lange JF, Kleinrensink GJ, Jeekel J, Lange JF (2007) Nerve management during open hernia repair. Br J Surg 94:17–22
Rutkow IM (2003) Demographic and socioeconomic aspects of hernia repair in the United States in 2003. Surg Clin N Am 83:1045–1051
Nasca TJ, Day SH, Amis ES Jr, ACGME Task Force (2010) The new recommendations on duty hours from the ACGME Task Force. N Engl J Med 363(2):e3
Kachalia A (2013) Improving patient safety through transparency. N Engl J Med 369:1677–1679
Bridges M, Diamond DL (1999) The financial impact of teaching surgical residents in the operating room. Am J Surg 177:28–32
Hassinger JP, Dozois EJ, Holubar SD, Camp JC, Farley DR, Fidler JL, Pawlina W, Robb RA, Larson DW (2010) Virtual pelvic anatomy simulator: a pilot study of usability and perceived effectiveness. J Surg Res 161:23–27
Neumayer L, Giobbie-Hurder A, Jonasson O, Fitzgibbons R Jr, Dunlop D, Gibbs J, Reda D, Henderson W, Veterans Affairs Cooperative Studies Program 456 Investigators (2004) Open mesh versus laparoscopic mesh repair of inguinal hernia. N Engl J Med 350:1819–1827
Zendejas B, Onkendi EO, Brahmbhatt RD, Lohse CM, Greenlee SM, Farley DR (2011) Long-term outcomes of laparoscopic totally extraperitoneal inguinal hernia repairs performed by supervised surgical trainees. Am J Surg 201:379–383 (discussion 383–384)
Wilkiemeyer M, Pappas TN, Giobbie-Hurder A, Itani KM, Jonasson O, Neumayer LA (2005) Does resident post graduate year influence the outcomes of inguinal hernia repair? Ann Surg 241:879–882 (discussion 882–884)
Zendejas B, Cook DA, Bingener J, Huebner M, Dunn WF, Sarr MG, Farley DR (2011) Simulation-based mastery learning improves patient outcomes in laparoscopic inguinal hernia repair: a randomized controlled trial. Ann Surg 254:502–509 (discussion 509–511)
Slater GH, Jourdan I, Folscher DJ, Snook AL, Cooper M, D’Allessandro P, Rangeley C, Bailey ME (2001) The Guildford MATTU TEP hernia model. Surg Endosc 15:493–496
Vassiliou MC, Feldman LS, Andrew CG, Bergman S, Leffondre K, Stanbridge D, Fried GM (2005) A global assessment tool for evaluation of intraoperative laparoscopic skills. Am J Surg 190:107–113
Bökeler U, Schwarz J, Bittner R, Zacheja S, Smaxwil C (2013) Teaching and training in laparoscopic inguinal hernia repair (TAPP): impact of the learning curve on patient outcome. Surg Endosc 27:2886–2893
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
PR, RR, JA, YA, BD and DF declare no conflict of interest.
Rights and permissions
About this article
Cite this article
Rowse, P.G., Ruparel, R.K., Abdelsattar, J.M. et al. TEP and Lichtenstein anatomy: does simulation accelerate acquisition among interns?. Hernia 20, 411–416 (2016). https://doi.org/10.1007/s10029-015-1409-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10029-015-1409-y