Endoscopic Component Separation Simulator Project

Bindhu Oommen, MD, MPH, Gregory J Mancini, MD, Melissa S Phillips, MD, Judy A Roark

University of Tennessee Medical Center in Knoxville

BACKGROUND: Reconstruction of the abdominal wall to repair ventral hernias with loss of domain remains challenging. The traditional technique of component separation by creating wide skin flaps has become an acceptable method, but predisposes to skin-flap necrosis and wound complication rates as high as 17-35%. Endoscopic component separation (ECS) is technically feasible and produces the same amount of fascial release as the conventional technique, with decreased incidence or complexity of skin-flap necrosis and postoperative wound infection. However, most practicing surgeons are unfamiliar with the proper technique for endoscopic component separation.

PURPOSE: The aim of this study was to present our simulation model for ECS and to describe the didactic and technical features of the simulator’s curriculum and validate the methodology in proper surgical technique.

METHODS: Our simulation model was field-tested as part of the Learning Center Program at the 2012 annual SAGES conference. Didactic material was presented focusing on teaching fundamental principles of both open and endoscopic component separation. After completing the simulation at the station, a short survey was administered.

RESULTS: The simulation was completed by forty-four participants. Over half of participants were in the 30-39 age group, and almost one-third were between 40-49 years old. Sixty-six percent of participants were practicing surgeons, with less than one to over 20 years of surgical experience; the remaining one-third was residents/fellows. More than half the group reported that over 50% of their ventral hernia repairs were done laparoscopically, and only 30% performed more than five component separations a year. Of those surgeons performing component separation, only 25% used the endoscopic technique. Independent t-test analysis indicated that practicing surgeons vs. resident/fellows were similar in how they perceived the model’s realistic tactile feedback and visual cues, as well as accomplishing the five objectives of the simulation model and likelihood of integrating the procedure into practice for complex hernia repair.

CONCLUSION: Based on our preliminary data, the simulator can augment the surgeon’s training and understanding of key anatomy and steps for performing an endoscopic component separation. While the initial pilot is encouraging, there needs to be further study with an increased sample size, including experts in the field, to validate the model and yield potential improvements that can be integrated into the next generation simulator.

Session: Poster Presentation

Program Number: P278