MSS14: THE DEVELOPMENT OF A COST EFFECTIVE LAPAROSCOPIC SKILLS TRAINER FOR TRANSABDOMINAL PREPERITONEAL (TAPP) AND TOTALLY EXTRAPERITONEAL (TEP) MESH PLACEMENT FOR SURGICAL TRAINEES
Jonathan Wang1; Emad Madha, MD2; Rodrigo Mateo, MD2; 1USUHS; 2WRNMMC
INTRODUCTION: Precise placement and fixation of hernia mesh in transabdominal preperitoneal (TAPP) and totally extraperitoneal (TEP) hernia repairs are critical skills for surgical trainees. Currently, existing commercial training models tend to be cost-prohibitive for many trainees and lack the fidelity required to replicate the anatomical challenges encountered in these surgeries. Existing models focus on broad laparoscopic skills, whereas our trainer specifically focuses on proficiency in hernia mesh placement and fixation, a key step in TAPP and TEP repairs. To meet this need, we developed a cost-effective, modular trainer using 3D printing to replicate the inguinal region, allowing trainees to practice these critical techniques with precision.
METHODS AND PROCEDURES: Using an iterative process, a modular trainer was developed matching the anatomical dimensions of the inguinal region critical to TAPP and TEP repairs. The model features a hollow structure to simulate the abdominal wall and incorporates a hook-and-loop fastener to replicate self-adhering hernia mesh placement. For non-self-adhering mesh, a silicone mold attachment can be used to replicate fixation. The trainer supports both unilateral and bilateral hernia repairs and can be integrated into existing Fundamentals of Laparoscopic Surgery (FLS) systems. The critical steps of port insertion, mesh unrolling, and fixation are captured, allowing users to practice these essential elements in a focused setting. A survey tool was developed to assess the fidelity of the trainer in these aspects.
RESULTS: A prototype is currently under evaluation, and a feedback survey isa underway to evaluate key metrics such as the realism of the anatomical structures, the difficulty of mesh unrolling, and the overall training utility. Board certified surgeons will evaluate the model and assess its fidelity as a training device by responding to the survey. Survey data will be used to refine the model and improve its utility and effectiveness as a training tool.
CONCLUSION: The hernia mesh trainer offers a practical, cost-effective solution for enhancing the training of TAPP and TEP hernia repairs. Surgical trainees are often expected to perform precise mesh placement and fixation during procedures, despite having limited prior experience with this complex task. This trainer provides a simulated platform for developing the necessary skills to manage mesh handling and fixation during laparoscopic hernia repair. Ongoing feedback from board-certified surgeons will help refine the model and improve its utility and effectiveness as a valuable tool in surgical education.