Is YouTube a Reliable Source for Minimally Invasive Inguinal Hernia Repair Training? A Comparative Analysis of...

YouTube has become a widely used tool for surgical education, offering open access to procedural videos for trainees and professionals alike. However, the reliability and pedagogical quality of these publicly available resources remain uncertain. In the context of minimally invasive inguinal hernia repair, we hypothesized that robotic (RT) surgery videos provide superior educational value compared with laparoscopic (LAP) ones. This study aimed to systematically evaluate and compare the quality of RT and LAP transabdominal preperitoneal (TAPP) inguinal hernia repair videos available on YouTube.

Based on a priori sample size calculation for moderate effect size (Cohen's d = 0.5), we determined that 63 videos per group would be required for adequate statistical power. On March 19, 2025, a structured search was performed on YouTube using the term "Transabdominal preperitoneal repair for inguinal hernia." This strategy generated an initial pool of 300 potentially eligible videos, which were screened sequentially until the predetermined sample size of 63 videos per group was achieved. Eligible content featured TAPP repairs via RT or LAP approach. Duplicates, non-inguinal TAPP procedures, videos consisting exclusively of animations, conference lectures, or irrelevant videos were excluded. The primary objective was to evaluate videos containing operative demonstrations of surgical procedures. After this selection, two blinded hernia surgeons independently assessed all videos using a newly developed 21-item qualitative evaluation tool and the validated LAParoscopic surgery Video Educational GuidelineS (LAP-VEGaS) score, a tool for evaluating surgery videos submitted to presentations and publications. Group comparisons were conducted using Welch's t-test and Mann-Whitney U test. Effect size was reported using Cohen's d. Both assessment tools demonstrated adequate inter-rater agreement and internal consistency, supporting their reliability for evaluating educational video content.

From 300 videos screened, 126 met inclusion criteria (63 RT, 63 LAP). RT videos scored significantly higher than LAP videos on the newly developed qualitative evaluation tool (mean score 0.54 vs. 0.44; P < .001; Cohen's d = -0.60), indicating a moderate effect size. Similarly, RT videos demonstrated higher LAP-VEGaS scores (7.46 vs. 6.34), although this difference did not reach statistical significance (P = .091). These findings suggest that RT videos present superior adherence to technical and educational standards, respectively. Both assessment tools demonstrated adequate inter-rater agreement and internal consistency, supporting their reliability for evaluating educational video content.

YouTube contains a large repository of TAPP repair videos, but quality is inconsistent. The new qualitative tool demonstrated strong reliability and internal consistency, supporting its use for educational video assessment. RT videos showed greater adherence to technical and educational standards compared with LAP. RT videos may therefore offer more structured learning content, but general quality improvements remain necessary across both approaches.