A Disease-Specific Simulator of the Laparoscopic Percutaneous Extraperitoneal Closure (LPEC) Method for Pediatric Inguinal Hernia: A Validation Study With Comparison of Experienced Pediatric Surgeons and Novices.

Background: Laparoscopic inguinal hernia repair is the most common procedure in the pediatric field and is one of the first pediatric endoscopic surgical procedures that a trainee should learn. Off-the-job training is important in pediatric surgery to compensate for the lack of experience due to the small number of cases. We developed a disease-specific simulator for laparoscopic percutaneous extraperitoneal closure (LPEC) of inguinal hernia. We compared the results of simulated surgery using this simulator between experts and novices.

Methods: The simulator was developed for a 1-year-old infant body size and allowed for training in needle manipulation unique to LPEC. The participants were pediatric surgeons and trainees and were divided into novice and experienced groups. The task involved simulated LPEC operations. The task completion time, three-dimensional characteristics of needle device manipulation evaluated by a magnetic three-dimensional position-measuring device, and accuracy of needle device manipulation evaluated by a checklist were compared. A questionnaire survey was conducted to evaluate the effectiveness of the simulator.

Results: There were 35 and 18 participants in the experienced and novice groups, respectively. The experienced group had a significantly shorter task completion time than the novice group (308.1 vs. 695.8 s, p < 0.001), shorter total pass length (37591.1 vs. 102678.1 mm, p = 0.001), slower average velocity (79.2 vs. 136.8 mm/s, p = 0.002), and lower average acceleration than the novice group (8477.9 vs. 17775.5 mm/s², p = 0.005). The experienced group showed significantly better performance in the evaluation using a checklist. In the questionnaire survey, the effectiveness of the simulator was highly evaluated by experienced surgeons.

Conclusion: Our simulator could clearly differentiate between novice and experienced surgeons, and the validity of the LPEC simulator was established. The validity of the LPEC simulator was also proven using a questionnaire survey after simulation surgery.