Simulated training model in a low cost for laparoscopic inguinal hernioplasty

This is an experimental study, 18 participants were selected, divided into three groups, experimental (GE) surgeons in training, control (GC) experienced surgeons and Shaw (GS) nonexperienced surgeons. The simulation in the 3D model was carried out in 6 sessions fulfilling the 5 stages. Opening the peritoneum with the creation of the preperitoneal space; identification of important structures; hernia identification and reduction; placement and fixation of the mesh in Cooper’s ligament and closure of the peritoneum.

Results

In the 1st stage, the GE obtained an average of 1.25 ± 0.42 in the 1st session and 3.25 ± 0.62 in the 6th session (p = 0.05) and in the 5th stage 0.91 ± 0.29 in the first session. 1st session and 1.91 ± 0.29 in the 6th session (p = 0.001), with no significant difference between groups. The learning and skill curve in the SG represented 1.08 ± 0.29 1st and 3.50 ± 0.90 6th session (p = 0.001).

Conclusions

The creation of a systematization of training in simulation applied to the three-dimensional model enabled gain in laparoscopic skills and underpinned its theoretical and practical foundations.

Key words
Inguinal Hernia; Laparoscopy; Simulation Training; Health Education; Three-Dimensional Printing

Variables		Surgeon group						P-value
Variables		EG		SG		CG		P-value
Age (years)		29.00 ± 2.73^† † Kruskal-Wallis/Dunn Test (mean ± standard deviation).		34.67 ± 1.53^† † Kruskal-Wallis/Dunn Test (mean ± standard deviation).		40.50 ± 6.36^† † Kruskal-Wallis/Dunn Test (mean ± standard deviation).		-
Sex
	Male	9	75.0%	2	66.7%	1	50.0%	0.762
	Female	3	25.0%	1	33.3%	1	50.0%	0.762
Dominant hand
	Right-handed	12	100.0%	3	100.0%	2	100.0%	1.000
	Left-handed	0	0.0%	0	0.0%	0	0.0%	1.000
Game (more than 3 h/week)
	No	5	41.7%	1	33.3%	2	100.0%	0.270
	Yes	7	58.3%	2	66.7%	0	0.0%	0.270
Ability with musical instrument
	No	11	91.7%	1	33.3%	2	100.0%	0.047
	Yes	1	8.3%	2	66.7%	0	0.0%	0.047
Specialty
	General surgery	12	100.0%	1	100.0%	0	100.0%	0.001
	Others	0	0.0%	2	66.7%	2	100.0%	0.001
Which laparoscopic procedures have confidence in performing
	Cholecystectomy	5	41.7%	3	100.0%	2	100.0%	0.084
	Appendectomy	3	25.0%	3^* * Friedman/Dunn Test,	100.0%	2^* * Friedman/Dunn Test,	100.0%	0.019
	Hernioplasty	0	0.0%	0	0.0%	2*	100.0%	< 0.001
	Fundoplication	0	0.0%	1	33.3%	2*	100.0%	0.002
Residence time/performance		11.67 ± 7.69		64.00 ± 18.33^* * Friedman/Dunn Test,		150.00 ± 42.43^* * Friedman/Dunn Test, ^† † Kruskal-Wallis/Dunn Test (mean ± standard deviation).		< 0.001
Estimated observation time/assistance with video surgery (hours)		192.50 ± 321.59		4253.33 ± 1397.33^* * Friedman/Dunn Test,		12000.00 ± 2828.43^* * Friedman/Dunn Test, ^† † Kruskal-Wallis/Dunn Test (mean ± standard deviation).		< 0.001
Estimated time of previous training in simulators (hours)		15.83 ± 27.46		63.33 ± 40.41^* * Friedman/Dunn Test,		425.00 ± 106.07^* * Friedman/Dunn Test, ^† † Kruskal-Wallis/Dunn Test (mean ± standard deviation).		< 0.001
Estimated time of previous operating room training (hours)		82.33 ± 137.60		600.00 ± 100.00^* * Friedman/Dunn Test,		4720.00 ± 1244.51^* * Friedman/Dunn Test, ^† † Kruskal-Wallis/Dunn Test (mean ± standard deviation).		< 0.001
Number of TAPP hernias performed		0.08 ± 0.29		0.67 ± 1.15		390.00 ± 339.41^* * Friedman/Dunn Test, ^† † Kruskal-Wallis/Dunn Test (mean ± standard deviation).		< 0.001
Laparoscopy experience time (months)		12.42 ± 8.71		6800 ± 13.86^* * Friedman/Dunn Test,		150.00 ± 42.43^* * Friedman/Dunn Test, ^† † Kruskal-Wallis/Dunn Test (mean ± standard deviation).		< 0.001

		Training sessions
		S1	S6	p-Value
1st stage	EG	1.25 ± 0.42aA	3.25 ± 0.62bB	0.002^* * Friedman / Dunn test,
	SG	3.33 ± 0.57B	0.285^† † Kruskal–Wallis / Dunn test (mean ± standard deviation).
	CG	4.00 ± 0.00B
P-value		< 0.001^† † Kruskal–Wallis / Dunn test (mean ± standard deviation).
2nd stage	EG	1.08 ± 0.67aA	2.58 ± 0.51cB	0.019^* * Friedman / Dunn test,
	SG	2.58 ± 0.31B	0.263^† † Kruskal–Wallis / Dunn test (mean ± standard deviation).
	CG	3.00 ± 0.00B
P-value		< 0.001^† † Kruskal–Wallis / Dunn test (mean ± standard deviation).
3rd stage	EG	1.00 ± 0.43aA	2.08 ± 0.29cB	0.004^* * Friedman / Dunn test,
	SG	2.00 ± 0.00B	0.831^† † Kruskal–Wallis / Dunn test (mean ± standard deviation).
	CG	2.00 ± 0.00B
P-value		0.001^† † Kruskal–Wallis / Dunn test (mean ± standard deviation).
4th stage	EG	1.08 ± 0.67aA	2.92 ± 0.29bB	< 0.001^* * Friedman / Dunn test,
	SG	2.67 ± 0.58B	0.468^† † Kruskal–Wallis / Dunn test (mean ± standard deviation).
	CG	3.00 ± 0.00B
P-value		0.001^† † Kruskal–Wallis / Dunn test (mean ± standard deviation).
5th stage	EG	0.91 ± 0.29ªA	1.91 ± 0.29bB	< 0.001^* * Friedman / Dunn test,
	SG	2.00 ± 0.00B	0.831^† † Kruskal–Wallis / Dunn test (mean ± standard deviation).
	CG	2.00 ± 0.00B
P-value		< 0.001^† † Kruskal–Wallis / Dunn test (mean ± standard deviation).
Laparoscopic skills	EG	1.08 ± 0.29aA	3.50 ± 0.90cC	< 0.001^* * Friedman / Dunn test,
	SG	5.00 ± 0.00B	0.012^† † Kruskal–Wallis / Dunn test (mean ± standard deviation).
	CG	5.00 ± 0.00B
P-value		< 0.001^† † Kruskal–Wallis / Dunn test (mean ± standard deviation).
Time (min)	EG	7.82 ± 3.74aA	4.73 ± 2.62aB	0.555^* * Friedman / Dunn test,
	SG	4.74 ± 1.79B	0.918^† † Kruskal–Wallis / Dunn test (mean ± standard deviation).
	CG	3.98 ± 0.58B
P-value		0.204^† † Kruskal–Wallis / Dunn test (mean ± standard deviation).
Score	EG	4.89 ± 0.92aA	14.22 ± 0.97dC	< 0.001^* * Friedman / Dunn test,
	SG	15.00 ± 0.00B	0.039^† † Kruskal–Wallis / Dunn test (mean ± standard deviation).
	CG	16.00 ± 0.00B
P-value		< 0.001^† † Kruskal–Wallis / Dunn test (mean ± standard deviation).

Sociedade Brasileira para o Desenvolvimento da Pesquisa em Cirurgia https://actacirbras.com.br/ - São Paulo - SP - Brazil
E-mail: actacirbras@gmail.com

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[1] *Corresponding author: luisfilho4@hotmail.com | (55 85)9912-2210