Paediatric laparoscopic hernia repair: Ex vivo skills in the reduced training era

Abstract

Introduction: Changes to surgical working hours have resulted in shorter training times and fewer learning opportunities. Tools that develop surgical
skills ex-vivo are of particular interest in this era. Laparoscopic skills are regarded as essential by many for modern paediatric surgery practice. Several generic skills models have been reported and validated. However, there is limited evidence regarding the role of procedure specific models. Here, a laparoscopic paediatric hernia repair model is trialled with surgical trainees and their competence compared with consultant colleagues.

Patients and Methods: An ex-vivo paediatric inguinal hernia repair model was devised. Surgical trainees from 5 specialist centres were recruited and performed multiple standardised repairs.

Results: 23 trainees performed 192 repairs. Experts performed 10 repairs
for comparison. Trainees were timed performing the repair and their  accuracy measured. With repeated attempts trainee’s timings and accuracy improved until by the 10th repair they were no different from benchmark consultant scores.

Conclusion: A simple, procedure specifi c ex-vivo training model has been
evaluated for laparoscopic hernia training in paediatric surgery. The results suggest improvements in competence with repetition. Trainee and  benchmark consultant scores are no different by the 10th trainee attempt. We conclude that this model may have a valuable role in the training and assessment of future paediatric surgeons.

Key words: Ex-vivo, hernia repair, laparoscopic, paediatric, training model