Advertisement

Hernia

pp 1–8 | Cite as

Development and evaluation of a novel simulation model for transabdominal preperitoneal (TAPP) inguinal hernia repair

  • G. IvakhovEmail author
  • A. Kolygin
  • S. Titkova
  • M. Anurov
  • A. Sazhin
Original Article

Abstract

Background

Transabdominal preperitoneal (TAPP) inguinal hernia repair requires the surgeon to have good manual skills in laparoscopic surgery, as well as an understanding of the laparoscopic features of the groin anatomy. This is why TAPP is considered a more difficult surgical procedure compared to open techniques. Realistic training model for TAPP inguinal hernia repair would enhance surgeons’ skills before they enter in the operation room. Our aim was to create a realistic, inexpensive, and easily reproducible model for laparoscopic TAPP inguinal hernia repair and to assess its effectiveness.

Methods

The applied TAPP inguinal hernia repair training simulator consists of a laparoscopic box and an inguinal region model placed in it. The model of the groin area is made of the porcine stomach and assembling materials. Uniaxial tensile and T-peel tests were performed to compare the mechanical properties of the porcine stomach and the human cadaver peritoneum. Thirty eight surgeons performed TAPP inguinal hernia repair using this model. Their opinions were scored on a five-point Likert scale.

Results

Close elastic modules of the porcine and human tissues (13.5 ± 4.2 kPa vs. 15.8 ± 6.7 kPa, p = 0.531) gave to trainees a realistic tissue feel and instrument usage. All participants strongly agreed that model was highly useful for TAPP inguinal hernia repair training. They also put the following points: the model as a whole 5 (3–5), simulation of anatomy 5 (3–5), simulation of dissection and mobilization 5 (3–5), and simulation of intracorporeal suture 5 (4–5).

Conclusions

We successfully created a model for TAPP inguinal hernia repair training. The model is made of inexpensive synthetic and biological materials similar to the human tissue. The model is easy to reproduce and can be used in the training programs of surgical residents.

Keywords

TAPP Training Simulation model Laparoscopy education 

Notes

Compliance with ethical standards

Conflict of interest

Georgy Ivakhov, Alexey Kolygin, Svetlana Titkova, Michail Anurov, and Alexander Sazhin have no conflicts of interest or financial ties to disclose.

Ethical approval

The study was approved by the institutional Ethics Committee of Pirogov Russian National Research Medical University.

Human and animal rights

This article does not contain any studies with human participants. No procedures were performed on animals in this study.

Informed consent

For this type of study, formal consent is not required.

Supplementary material

Supplementary file1 (MOV 124223 kb)

References

  1. 1.
    Andresen K, Friis-Andersen H, Rosenberg J (2016) Laparoscopic repair of primary inguinal hernia performed in public hospitals or low-volume centers have increased risk of reoperation for recurrence. Surg Innov 23:142–147CrossRefGoogle Scholar
  2. 2.
    Trevisonno M, Kaneva P, Watanabe Y, Fried GM, Feldman LS, Andalib A, Vassiliou MC (2015) Current practices of laparoscopic inguinal hernia repair: a population-based analysis. Hernia 19:725–733CrossRefGoogle Scholar
  3. 3.
    Vu JV, Gunaseelan V, Krapohl GL, Englesbe MJ, Campbell DA, Dimick JB, Telem DA (2018) Surgeon utilization of minimally invasive techniques for inguinal hernia repair: a population-based study. Surg Endosc.  https://doi.org/10.1007/s00464-018-6322-x CrossRefPubMedGoogle Scholar
  4. 4.
    Trevisonno M, Kaneva P, Watanabe Y, Fried GM, Feldman LS, Lebedeva E, Vassiliou MC (2015) A survey of general surgeons regarding laparoscopic inguinal hernia repair: practice patterns, barriers, and educational needs. Hernia 19:719–724CrossRefPubMedGoogle Scholar
  5. 5.
    Suguita Fabio Yuji, Essu FF, Oliveira LT, Iuamoto LR, Kato JM, Torsani MB, Franco AS, Meyer A, Andraus W (2017) Learning curve takes 65 repetitions of totally extraperitoneal laparoscopy on inguinal hernias for reduction of operating time and complications. Surg Endosc 31:3939–3945CrossRefPubMedGoogle Scholar
  6. 6.
    Leblanc F, Champagne BJ, Augestad KM, Neary PC, Senagore AJ, Ellis CN, Delaney CP (2010) A comparison of human cadaver and augmented reality simulator models for straight laparoscopic colorectal skills acquisition training. J Am Coll Surg 211:250–255CrossRefPubMedGoogle Scholar
  7. 7.
    Nishihara Y, Isobe Y, Kitagawa Y (2017) Validation of newly developed physical laparoscopy simulator in transabdominal preperitoneal (TAPP) inguinal hernia repair. Surg Endosc 31:5429–5435CrossRefPubMedGoogle Scholar
  8. 8.
    Sharma M, Horgan A (2012) Comparison of fresh-frozen cadaver and high-fidelity virtual reality simulator as methods of laparoscopic training. World J Surg 36:1732–1737CrossRefPubMedGoogle Scholar
  9. 9.
    Yiasemidou M, Roberts D, Glassman D, Tomlinson J, Biyani S, Miskovic D (2017) A multispecialty evaluation of thiel cadavers for surgical training. World J Surg 41:1201–1207CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    The Herniasurge Group (2018) International guidelines for groin hernia management. Hernia 22:1–165CrossRefGoogle Scholar
  11. 11.
    Bittner R, Arregui ME, Bisgaard T, Dudai M, Ferzli GS, Fitzgibbons RJ, Fortelny RH, Klinge U, Kockerling F, Kuhry E, Kukleta J, Lomanto D, Misra MC, Montgomery A, Reinpold W, Rosenberg J, Sauerland S, Singh K, Timoney M, Weyhe D, Chowbey P (2011) Guidelines for laparoscopic (TAPP) and endoscopic (TEP) treatment of inguinal hernia [International Endohernia Society (IEHS)]. Surg Endosc 25:2773–2843CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Bittner R, Montgomery MA, Arregui E, Bansal V, Bingener J, Bisgaard T, Buhck H, Dudai M, Ferzli GS, Fitzgibbons RJ, Fortelny RH, Grimes KL, Klinge U, Koeckerling F, Kumar S, Kukleta J, Lomanto D, Misra MC, Morales-Conde S, Reinpold W, Rosenberg J, Singh K, Timoney M, Weyhe D, Chowbey P (2015) Update of guidelines on laparoscopic (TAPP) and endoscopic (TEP) treatment of inguinal hernia (International Endohernia Society). Surg Endosc 29:289–321CrossRefGoogle Scholar
  13. 13.
    Lorenz R, Stechemesser B, Reinpold W, Fortelny R, Mayer F, Schröder W, Köckerling F (2017) Development of a standardized curriculum concept for continuing training in hernia surgery: German Hernia School. Hernia 21(2):153–162CrossRefPubMedGoogle Scholar
  14. 14.
    Kurashima Y, Feldman L, Al-Sabah S, Kaneva P, Fried G, Vassiliou M (2011) A novel low-cost simulator for laparoscopic inguinal hernia repair. Surg Innov 18:171–175CrossRefPubMedGoogle Scholar
  15. 15.
    Hoops HE, Maynard E, Brasel KJ (2017) Training surgeons in the current US Healthcare System : a review of recent changes in resident education. Curr Surg Reports.  https://doi.org/10.1007/s40137-017-0195-0 CrossRefGoogle Scholar
  16. 16.
    Kurashima Y, Feldman LS, Kaneva PA, Fried GM, Bergman S, Demyttenaere SV, Li C, Vassiliou MC (2014) Simulation-based training improves the operative performance of totally extraperitoneal (TEP) laparoscopic inguinal hernia repair: a prospective randomized controlled trial. Surg Endosc 28:783–788CrossRefPubMedGoogle Scholar
  17. 17.
    Schlottmann F, Murty NS, Patti MG (2017) Simulation model for laparoscopic foregut surgery: the University of North Carolina foregut model. J Laparoendosc Adv Surg Tech 27:1–5CrossRefGoogle Scholar
  18. 18.
    Kurashima Y, Feldman LS, Al-Sabah S, Kaneva PA, Fried GM, Vassiliou MC (2011) A tool for training and evaluation of laparoscopic inguinal hernia repair: the Global Operative Assessment of Laparoscopic Skills-Groin Hernia (GOALS-GH). Am J Surg 201:54–61CrossRefPubMedGoogle Scholar
  19. 19.
    Lee JS, Hong TH (2015) In vivo porcine training model for laparoscopic Roux-en-Y choledochojejunostomy. Ann Surg Treat Res 88:306–310CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Kim EY, Hong TH (2018) In vivo porcine training model of laparoscopic common bile duct repair with T-tube insertion under the situation of iatrogenic common bile duct injury. Ann Surg Treat Res 94:142–146CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    White EJ, Cunnane EM, Mcmahon M, Walsh MT, Coffey JC, Sullivan LO (2018) Mechanical characterisation of porcine non-intestinal colorectal tissues for innovation in surgical instrument design. J Eng Med 232:796–806CrossRefGoogle Scholar
  22. 22.
    The HerniaSurg Group (2018) International guidelines for groin hernia management. Hernia 22:1–165.  https://doi.org/10.1007/s10029-017-1668-x CrossRefGoogle Scholar
  23. 23.
    Köckerling F (2018) What is the influence of simulation-based training courses, the learning curve, supervision, and surgeon volume on the outcome in hernia repair? A Systematic Review. Front Surg. 5:57.  https://doi.org/10.3389/fsurg.2018.00057 (Published online 25 Sep 2018) CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Faculty SurgeryPirogov Russian National Research Medical UniversityMoscowRussia
  2. 2.Department of Experimental SurgeryPirogov Russian National Research Medical UniversityMoscowRussia

Personalised recommendations