Improving operative performance using a laparoscopic hernia simulator.
BACKGROUND
Traditionally, the acquisition of surgical skill has occurred entirely in the operating room. To meet the expanding challenges of cost containment and patient safety, novel methods of surgical training utilizing ex-vivo workstations are being developed. The purpose of our study was to evaluate the impact of a laparoscopic training curriculum on surgical residents' operative performance.


METHODS
Twenty-one surgery residents completed baseline laparoscopic total extraperitoneal (TEP) hernia repairs. Operative performance was evaluated using a validated global assessment tool. Each resident was then randomized to a control group or a trained group. A CD ROM, video, and simulator were used for training. At the end of the study, each resident's operative performance was again evaluated.


RESULTS
Improvement was significantly greater in the trained group in five of the eight individual global assessment areas as well as the composite score (P <0.05). Questionnaire data suggested that training resulted in improved understanding of the TEP hernia repair (P = 0.01) and an increased willingness to offer the operation to patients with nonrecurrent unilateral hernias (P = 0.02).


CONCLUSIONS
A multimodality laparoscopic TEP hernia curriculum improves residents' knowledge of the TEP hernia repair and comfort in performing the procedure, and may also improve actual operative performance.
Hamilton
E C
EC
Southwestern Center for Minimally Invasive Surgery, Department of Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-9092, USA.
Scott
D J
DJ
Kapoor
A
A
Nwariaku
F
F
Bergen
P C
PC
Rege
R V
RV
Tesfay
S T
ST
Jones
D B
DB
D002983:Clinical Competence / Q000592:standards; D003479:Curriculum; D004521:Educational Measurement; D013502:General Surgery / Q000193:education*; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D007396:Internship and Residency; D010535:Laparoscopy; D008953:Models, Anatomic