C T Zipper1, U Friedrich1, J Backhaus2, S König2, S Mavroveli3, A Wiegering1,4, S Olbrecht5, F Puppe5, S A Günster6, U A Dietz7,8. 1. Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital Wuerzburg, Oberduerrbacher Strasse 6, 97080, Wuerzburg, Germany. 2. Institute of Medical Teaching and Medical Education Research, University of Wuerzburg, Josef-Schneider Strasse 2, 97080, Wuerzburg, Germany. 3. London General Surgical Skills Programme, Imperial College London, South Wharf Road, Paddington, London, W2 1BL, UK. 4. Department of Biochemistry and Molecular Biology, University of Wuerzburg, Am Hubland, 97074, Wuerzburg, Germany. 5. Institute for Artificial Intelligence and Applied Informatics (VI), University of Wuerzburg, Am Hubland, 97074, Wuerzburg, Germany. 6. Institut für Allgemeinmedizin, Friedrich-Alexander-Universitaet Erlangen-Nuernberg, Universitaetsstrasse 29, 91054, Erlangen, Germany. 7. Department of General, Visceral, Vascular and Pediatric Surgery, University Hospital Wuerzburg, Oberduerrbacher Strasse 6, 97080, Wuerzburg, Germany. ulrich.dietz@spital.so.ch. 8. Department of General, Visceral, Vascular and Thoracic Surgery, Kantonsspital Olten (soH), Baselstrasse 150, 4600, Olten, Switzerland. ulrich.dietz@spital.so.ch.
Abstract
BACKGROUND: Incisional hernia repair requires detailed anatomic knowledge. Regarding median subxiphoidal hernias, the proper preparation of the fatty triangle is challenging. To foster proficiency-based training, a cost-efficient model for open median retromuscular mesh repair resembling the human body was developed, including the main anatomical structures related to the procedure. The aim is to create and validate a high-fidelity model on open retromuscular mesh repair suitable for "training before doing". MATERIALS AND METHODS: Different types of fabrics for imitation of connective tissue and 2-component silicones were used to construct the incisional hernia model. Sample size for validation of the model was determined by a triangular testing approach. Operations from six beginners and six experts were assessed by three blinded-raters. Reliability and construct-validity were evaluated on a behaviorally anchored rating scale (highest score: 4) for the criteria: "instrument use", "tissue handling", "near misses and errors", and "end-product quality". RESULTS: The model authentically mimicked an open median retromuscular mesh repair. Participants considered the procedure realistic. Reliability was excellent, ranging from 0.811 to 0.974 for "end-product quality", and "tissue handling" respectively. Construct-validity was confirmed with experts significantly outperforming beginners in the "use of instruments" (Mbeg. = 2.33, Mexp. = 3.94, p < 0.001), "tissue handling" (Mbeg. = 2.11, Mexp. = 3.72, p < 0.001), "near misses and errors" (Mbeg. = 2.67, Mexp. = 3.67, p < 0.001), and "end-product quality" (Mbeg. = 2.78, Mexp. = 3.72, p < 0.001). Criterion-validity revealed a paradox effect: beginners performed significantly better than experts (p < 0.05) when preparing the fatty triangle. CONCLUSIONS: The model covers all relevant aspects involved in median-open retromuscular incisional hernia mesh repair. Performance differences between beginners and experts confirm construct-validity and thereby realism of the model. It enables to efficiently improve and practice technical skills of the demanding surgery.
BACKGROUND: Incisional hernia repair requires detailed anatomic knowledge. Regarding median subxiphoidal hernias, the proper preparation of the fatty triangle is challenging. To foster proficiency-based training, a cost-efficient model for open median retromuscular mesh repair resembling the human body was developed, including the main anatomical structures related to the procedure. The aim is to create and validate a high-fidelity model on open retromuscular mesh repair suitable for "training before doing". MATERIALS AND METHODS: Different types of fabrics for imitation of connective tissue and 2-component silicones were used to construct the incisional hernia model. Sample size for validation of the model was determined by a triangular testing approach. Operations from six beginners and six experts were assessed by three blinded-raters. Reliability and construct-validity were evaluated on a behaviorally anchored rating scale (highest score: 4) for the criteria: "instrument use", "tissue handling", "near misses and errors", and "end-product quality". RESULTS: The model authentically mimicked an open median retromuscular mesh repair. Participants considered the procedure realistic. Reliability was excellent, ranging from 0.811 to 0.974 for "end-product quality", and "tissue handling" respectively. Construct-validity was confirmed with experts significantly outperforming beginners in the "use of instruments" (Mbeg. = 2.33, Mexp. = 3.94, p < 0.001), "tissue handling" (Mbeg. = 2.11, Mexp. = 3.72, p < 0.001), "near misses and errors" (Mbeg. = 2.67, Mexp. = 3.67, p < 0.001), and "end-product quality" (Mbeg. = 2.78, Mexp. = 3.72, p < 0.001). Criterion-validity revealed a paradox effect: beginners performed significantly better than experts (p < 0.05) when preparing the fatty triangle. CONCLUSIONS: The model covers all relevant aspects involved in median-open retromuscular incisional hernia mesh repair. Performance differences between beginners and experts confirm construct-validity and thereby realism of the model. It enables to efficiently improve and practice technical skills of the demanding surgery.
Authors: Lawrence W Way; Lygia Stewart; Walter Gantert; Kingsway Liu; Crystine M Lee; Karen Whang; John G Hunter Journal: Ann Surg Date: 2003-04 Impact factor: 12.969
Authors: C T Zipper; U Friedrich; J Backhaus; S König; S Mavroveli; A Wiegering; S Olbrecht; F Puppe; S A Günster; U A Dietz Journal: Hernia Date: 2019-12-02 Impact factor: 4.739
Authors: C T Zipper; U Friedrich; J Backhaus; S König; S Mavroveli; A Wiegering; S Olbrecht; F Puppe; S A Günster; U A Dietz Journal: Hernia Date: 2019-12-02 Impact factor: 4.739