Incisional hernia repair in a high-fidelity silicone model for open retro-muscular mesh implantation with preparation of
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ORIGINAL ARTICLE
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 C. T. Zipper1 · U. Friedrich1 · J. Backhaus3 · S. König3 · S. Mavroveli4 · A. Wiegering1,6 · S. Olbrecht5 · F. Puppe5 · S. A. Günster7 · U. A. Dietz1,2 Received: 19 July 2019 / Accepted: 17 November 2019 © Springer-Verlag France SAS, part of Springer Nature 2019
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 constructvalidity 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
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