Validity of a low-cost Lichtenstein open inguinal hernia repair simulation model for surgical training

Hernia. 2020 Aug;24(4):895-901. doi: 10.1007/s10029-019-02093-6. Epub 2019 Dec 2.


Purpose: Simulation training allows trainees to gain experience in a safe environment. Computer simulation and animal models to practice a Lichtenstein open inguinal hernia repair (LOIHR) are available; however, a low-cost model is not. We constructed an inexpensive model using fabric, felt, and yarn that simulates the anatomy and hazards of the LOIHR. This study examined the fidelity, and perceived usefulness of our developed simulation model by surgical residents and expert surgeons.

Methods: A total of 66 Dutch surgical residents and ten international expert surgeons were included. All participants viewed a video-demonstration of LOIHR on the simulation model and subsequently performed the surgery themselves on the model. Afterward, they assessed the model by rating 13 statements concerning its fidelity (six model, three equipment, and four psychological) and six usefulness statements on a five-point Likert scale. One-sample Wilcoxon signed-rank test was used to compare to the neutral value of 3.

Results: The fidelity was assessed as being high by residents [model 4.00 (3.00-4.00), equipment 4.00 (3.00-4.00), psychological 4.00 (3.00-4.00); all p's < 0.001] and by expert surgeons [model 4.00 (3.00-4.00), p = 0.025; equipment 4.00 (3.00-5.00), p < 0.001; psychological 4.00 (3.00-4.00), p = 0.053]. The usefulness was rated high by residents and experts, especially the usefulness for training of residents [residents 4.00 (4.00-5.00), p < 0.001; experts 4.50 (3.75-5.00), p = 0.015].

Conclusion: Our developed Lichtenstein open inguinal hernia repair simulation model was assessed by surgical residents and expert surgeons as a model with high fidelity and high potential usefulness, especially for the training of surgical residents.

Keywords: Liechtenstein; Open inguinal hernia repair; Simulation model; Surgical education.

MeSH terms

  • Adult
  • Computer Simulation / standards*
  • Cost-Benefit Analysis
  • Hernia, Inguinal / economics*
  • Hernia, Inguinal / surgery*
  • Herniorrhaphy / education*
  • Humans
  • Laparoscopy / education*