Surgical Skills Improvement Using a Low-Cost Laparoscopic Simulator for Ventral Incisional Hernia.

Introduction: Ventral incisional hernia is one of the most common procedures in laparoscopic surgery, however, it requires proper training before doing it in the operating room. We propose a low-cost mechanical simulator with a new optical system to learn the basic steps of the procedure and improve surgical laparoscopic skill.

Materials And Methods: From November 3, 2014 to January 4, 2015, five residents and five surgeons with no prior laparoscopic experience, as well as two laparoscopic expert surgeons, participated in our study. They repeated the procedure three times per day for seven days. From January 10, 2015 to April 21, 2015, the five trained and five non-trained residents performed (each) five real laparoscopic ventral or median incisional hernia repairs under senior supervision. Operative time, decision making capabilities, number of errors, laparoscopic skill, and depth perception were compared between the two groups.

Results: A multiple regression (R) model was calculated and F-test showed a significant relation between operative time and numbers of procedures with the laparoscopic simulator (p<0.001) for the resident and non-laparoscopic surgeons groups and a multiple R-squared = 0.9974 (highly significant) of the model. No statistical difference was found between residents and non-laparoscopic surgeons (p<0.001), but both groups reached the same level as the expert surgeons after intensive training. Kruskal-Wallis was used to show an increased operative time for non-trained group. Pearson test and t-test showed a lower number of errors and failure in the trained group.

Conclusions: These results indicate that this new model of simulator could shorten the learning curve of surgical trainees for laparoscopic incisional hernia.