Incisional hernia repair in a high-fidelity silicone model for open retro-muscular mesh implantation with preparation of the fatty triangle: validation and educational impact study

Zipper CT, Friedrich U, Backhaus J, Koenig S, Mavroveli S, Wiegering A, Olbrecht S, Puppe F, Günster S, Dietz UA (2019)

Publication Type: Journal article

Publication year: 2019

Journal

DOI: 10.1007/s10029-019-02094-5

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.

Authors with CRIS profile

Simone Günster Institute of General Practice

Involved external institutions

Universitätsklinikum Würzburg

Germany (DE) Julius-Maximilians-Universität Würzburg

Germany (DE) Imperial College London / The Imperial College of Science, Technology and Medicine

United Kingdom (GB)

How to cite

APA:

Zipper, C.T., Friedrich, U., Backhaus, J., Koenig, S., Mavroveli, S., Wiegering, A.,... Dietz, U.A. (2019). Incisional hernia repair in a high-fidelity silicone model for open retro-muscular mesh implantation with preparation of the fatty triangle: validation and educational impact study. Hernia. https://doi.org/10.1007/s10029-019-02094-5

MLA:

Zipper, C. T., et al. "Incisional hernia repair in a high-fidelity silicone model for open retro-muscular mesh implantation with preparation of the fatty triangle: validation and educational impact study." Hernia (2019).

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