Evidence map›Paper›PMID 39900862›Full record

Trial reportSurgical endoscopy2025

A comparative study on trocar configurations and the use of steerable instruments in totally extraperitoneal inguinal hernia surgery training.

M E C M van de Pas, R R Postema, H P Theeuwes, J W A Klok, M Rahimi, C Verhoef, Tim Horeman

Abstract readRandomized Controlled TrialComparative StudyMulticenter Study
In one paragraph

Trial report in Surgical endoscopy, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors.

M E C M van de Pas *Department of Biomechanical Engineering, Faculty of BioMechanical Engineering, Delft University of Technology, Mekelweg 2 (Building 34), 2628CD, Delft, The Netherlands.
R R Postema *Department of Biomechanical Engineering, Faculty of BioMechanical Engineering, Delft University of Technology, Mekelweg 2 (Building 34), 2628CD, Delft, The Netherlands.
H P TheeuwesErasmus MC SkillsLab, Rotterdam, The Netherlands.
J W A KlokDepartment of Biomechanical Engineering, Faculty of BioMechanical Engineering, Delft University of Technology, Mekelweg 2 (Building 34), 2628CD, Delft, The Netherlands.
M RahimiDepartment of Surgery, Amsterdam UMC - VU University Medical Center, Amsterdam, The Netherlands.
C VerhoefDepartment of Surgery, Erasmus MC, Rotterdam, The Netherlands.
Tim HoremanDepartment of Biomechanical Engineering, Faculty of BioMechanical Engineering, Delft University of Technology, Mekelweg 2 (Building 34), 2628CD, Delft, The Netherlands. t.horeman@tudelft.nl.ORCID 0000-0002-8527-4486

Funding

ZonMw KICH1.ST03.21.002
6 · The paper itself

Abstract

backgroundTotally extraperitoneal (TEP) inguinal hernia surgery is a commonly performed but technically challenging procedure with a long learning curve. As TEP can be executed using two different trocar placements: a midline or a triangular configuration, the question remains which one is technically easier to master.

methodsIn a multicenter crossover-study, medical students were randomised into two groups and executed tasks on a box trainer that measured time, volume and force parameters. Additionally, the study assessed whether the SATA instrument, a steerable laparoscopic instrument that articulates the instrument's tip, would reduce the difficulty of performing the tasks in the midline configuration. After training, all participants executed a first experiment using both trocar configurations, followed by a second experiment executed with steerable and non-steerable instruments in the midline configuration. Subjective and objective performances per condition and learning curves were assessed.

resultsParticipants were faster and showed lower peak forces in the triangulated configuration. Learning curve analysis showed a positive improvement in time and path length in the midline configuration. Although participants rated ergonomics and intuitiveness similarly between the instruments, they found the task easier with the SATA instruments, ranking the added value of the steering function as 5 out of 5. Objectively, time and path length showed no significant differences while exerted forces were lower when using conventional instruments.

conclusionAlthough the midline configuration is preferred in terms of comfort and posture, the findings indicate that, for inexperienced practitioners, performing TEP surgery in midline configuration is both subjectively and objectively more challenging, highlighting the need for extensive training to overcome its difficulties and possibly shorten its learning curve. Although instruments with additional steering functions were preferred over conventional instruments in the more challenging midline configuration, additional steering complexity did not result in better parameter outcomes, showing the need for more extensive training.

Indexed as

Hernia, InguinalHerniorrhaphyLaparoscopyAdultClinical CompetenceCross-Over StudiesEquipment DesignFemaleHumansLearning CurveMaleStudents, MedicalSurgical InstrumentsYoung AdultHernia repairLaparoscopyMidline configurationSATASteerable instrumentsTEP

Identifiers

PMID39900862
PMCPMC11870937

What OpenQuestion holds

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LicenceCC BY
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.