Artikel
Endoscopic skills for groin hernia repair can be learned and trained in the lab: Presentation of a new TAPP-teacher
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Autoren
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Ulrich Dietz
- Universitätsklinikum Würzburg, Chirurgie I, Würzburg, Deutschland
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Christoph-Thomas Germer
- Universitätsklinikum Würzburg, Chirurgie I, Würzburg, Deutschland
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Armin Wiegering
- Universitätsklinikum Würzburg, Chirurgie I, Würzburg, Deutschland
| Veröffentlicht: | 21. April 2016 |
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Gliederung
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Background: A new training module for TAPP is presented. The module was developed to resemble realistic anatomical proportions and coordination of movements, mimicking a real TAPP procedure (face validity). The teacher was designed to comprehend and expose all the theoretical knowledge needed to avoid technical errors.
Materials and methods: The laparoscopic image is provided by a Telepac System (Storz) and a commercially available Pelvitrainer, using classical laparoscopic instruments. The teacher is modelled on softcast. The endoscopic view of the groin region shows direct parallelism to the human anatomy, including the shape of the lesser pelvis (important form mesh accommodation), the spermatic cord, the spermatic vessels, the epigastric vessels, the iliacal vessels, the nerves as well as the respective hernia orifices median, lateral and femoral. There is the possibility of ligation of the hernia sac (direct hernia) and of retrieval of preperitoneal fatty tissue from the inguinal canal (indirect hernia). The peritoneum-substitute used can be cutted, parietalized and sutured with commercially available suture materials and is easy to be replaced between two training units (about 1 minute à 20c/session).
Results: We have tested the TAPP-teacher in a pilot study with trainees without any TAPP experience (n=4) and with experienced surgeons (n=6) as well as in four training courses (n=52). Content validity (theoretic steps, anatomy, different hernia types, cutting of peritoneum, parietalization of the structures, insertion and positioning of the mesh. mesh fixation as well as suture of the peritoneum) and construct validity (participants with previous experience had clearly more proficiency in solving the tasks than beginners) were demonstrated. Predictive validity has to be shown in future studies. A prerequisite for this will be the development of an evaluation system for real TAPP procedures in the OR and should be developed in cooperation with the ongoing education-module of the EHS.
Figure 1 [Fig. 1]
