Development of a simulation-based laparoscopic ventral rectopexy module: skills training for minimally invasive...

Laparoscopic pelvic surgery presents significant technical challenges due to anatomical constraints such as limited working space and proximity to neurovascular structures. Laparoscopic ventral mesh rectopexy (LVMR) was selected as the procedural framework for model design and validation, given its complexity and relevance as a representative pelvic procedure. This study aimed to develop and validate a synthetic and reproducible simulation model with structural and functional fidelity to support the acquisition of laparoscopic skills in anatomically restricted pelvic environments.

A synthetic pelvic model was developed through iterative prototyping, integrating 3D-printed bone structures and platinum-cured silicone. Face validity and user reaction were initially assessed by eleven surgeons with varying expertise. Construct validity was then evaluated through performance in a simulated LVMR, using modified Objective Structured Assessment of Technical Skills (OSATS) and a Procedure-Specific Rating Scale (SRS). Surgical time was recorded by procedural steps. Data were analyzed using non-parametric methods.

Experts achieved significantly higher OSATS scores (median 20.5 [20.38-21]) than non-experts (16 [14.75-17.25]; p = 0.01), and higher SRS scores (16.25 [16-16.88] vs. 13.5 [13.25-15]; p = 0.009). Step-specific advantages were observed in surgical flow (p = 0.025) and knot tying (p = 0.018). Although global operative time was shorter in experts (29.3 vs. 52.8 min), it was not statistically significant (p = 0.073). Most participants described the model as realistic, useful, and representative of actual surgical conditions.

This validated, reusable model provides strong educational value for advanced laparoscopic pelvic training and structured skill acquisition.