Validation of a Novel, Low-Cost Simulator for Laparoscopic Hiatal Hernia Repair and Fundoplication

J Babowice, P Suarez, W Denham, J Linn, S Haggerty, R Tanaka, M Gitelis, J Carbray, M Ujiki. NorthShore University HealthSystem.

Background: Laparoscopic simulation has become a widely accepted methodology in surgical training; however, few procedure specific training models have been developed and validated. The purpose of this study was to develop and validate a training model specific to hiatal hernia repair and fundoplication (HHRaF), including the initiation of a standardized scoring rubric for evaluation.

Methods: A reproduction of correctable human hiatal hernia anatomy was assembled for use with laparoscopic tools and training video towers. A group of five novice (students), ten intermediate (senior residents), and five expert (attending foregut surgeons) participants were videotaped and assessed in HHRaF proficiency using the simulator by a team of blinded, expert surgeon video reviewers. A standardized HHRaF scoring rubric adapted from the Global Operative Assessment of Laparoscopic Skills was created.

Results: Participants were assessed on their ability to properly communicate equipment needs, use equipment correctly, suture close the hiatus, perform a fundoplication, and manipulate instruments. Expert group participants performed significantly better than intermediate and novice group participants in every scoring category and required significantly less time to complete the procedure (p=0.007). Intermediate group members performed significantly better than novices in communicating equipment needs (p<0.05), correct use of equipment (p=0.02), and instrument manipulation (p=0.02), but not hiatus closure or fundoplication. Inter-rater reliability using the scoring rubric was >0.72 for all scoring items and internal consistency of scoring items was 0.95. All three participant groups objectively reported the model to be an effective training tool and video reviewers objectively reported it to be an effective teaching tool.

Conclusion: The hiatal hernia and fundoplication simulation model is an effective training and evaluation tool and its partner scoring rubric is a reliable and valid measure of HHRaF specific knowledge and skills.

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