title: Simulation-based training improves the operative performance of totally extraperitoneal (TEP) laparoscopic inguinal hernia repair: a prospective randomized controlled trial.
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.
authors.affiliation: Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montreal, QC, Canada, yo.kurashima@huhp.hokudai.ac.jp.
authors.forename: Yo
authors.initials: Y
authors.lastname: Kurashima
authors.forename: Liane S
authors.initials: LS
authors.lastname: Feldman
authors.forename: Pepa A
authors.initials: PA
authors.lastname: Kaneva
authors.forename: Gerald M
authors.initials: GM
authors.lastname: Fried
authors.forename: Simon
authors.initials: S
authors.lastname: Bergman
authors.forename: Sebastian V
authors.initials: SV
authors.lastname: Demyttenaere
authors.forename: Chao
authors.initials: C
authors.lastname: Li
authors.forename: Melina C
authors.initials: MC
authors.lastname: Vassiliou
mesh_terms: D002983:Clinical Competence / Q000592:standards*; D003198:Computer Simulation; D003479:Curriculum / Q000592:standards; D004502:Education, Medical, Continuing / Q000592:standards*; D005260:Female; D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy / Q000193:education* / Q000379:methods; D006801:Humans; D007396:Internship and Residency / Q000379:methods*; D010535:Laparoscopy / Q000193:education*; D008297:Male; D010537:Peritoneum; D011446:Prospective Studies; D011795:Surveys and Questionnaires