Preoperative skill evaluation in transabdominal preperitoneal (TAPP) inguinal hernia repair using a three-dimensional printed TAPP repair simulator



Although transabdominal preperitoneal laparoscopic inguinal hernia repair (TAPP LIHR) is becoming increasingly more critical in the management of hernias, it has a long learning curve. The learning curve is often measured by a shortened operative time without mention of the quality of the procedure. This study was performed to evaluate the efficacy of a three-dimensional printed TAPP LIHR simulator to evaluate the surgeon’s preoperative skill before entering the operative theater.


Fifteen surgeons in our institution were enrolled in this study. They performed simulation TAPP LIHR while being video recorded. The TAPP LIHR simulator allows for the performance of all procedures required in TAPP LIHR. All participants were classified according to several background factors: postgraduate years (PGYs) (1–5, 6–10, or > 10), number of TAPP LIHR procedures performed (< 10, 11–49, or > 50), and number of laparoscopic surgeries performed (≤ 100 or > 100). The correlation among PGYs, the number of TAPP repairs performed, and the checklist score was evaluated.


The mean total score and time required to perform TAPP LIHR were significantly different among the three TAPP LIHR experience groups (< 10, 11–49, and > 50 procedures; P < 0.05). The checklist score and time required to perform TAPP LIHR were strongly correlated with the number of TAPP LIHR procedures performed (r = 0.74 and r = 0.69, respectively). However, the checklist score showed a weak correlation with PGY (r = 0.52).


Preoperative skill evaluation using a TAPP LIHR simulator and TAPP repair checklist supports the distinction between novices and experts. Both education systems are a valuable and affordable tool for evaluation and training of TAPP LIHR.

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We would like to thank all the participants who voluntarily participated in this study. We also thank Angela Morben, DVM, ELS, from Edanz Group (, for editing a draft of this manuscript.

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Correspondence to Yuichi Nishihara.

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Yuichi Nishihara and Yoh Isobe have no conflicts of interest or financial ties to disclose.

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Nishihara, Y., Isobe, Y. Preoperative skill evaluation in transabdominal preperitoneal (TAPP) inguinal hernia repair using a three-dimensional printed TAPP repair simulator. Surg Endosc 35, 270–274 (2021).

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  • TAPP repair
  • 3D printing
  • Surgical education
  • Surgical simulation