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TissueDB/Simulators/Laparoscopic Inguinal Hernia Repair Simulator (Kurashima)

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General Information

The Laparoscopic Inguinal Hernia Repair Simulator (Kurashima) — also known as the McGill Laparoscopic Inguinal Hernia Simulator (MLIHS) — is a low-cost benchtop trainer for laparoscopic inguinal hernia repair.[1] It supports both the totally extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) techniques on a standard laparoscopic tower. A reusable inguinal-anatomy assembly carries a disposable multilayer abdominal-wall model, so a trainee can work the whole procedure on a single bench.[1] The procedure runs from trocar placement through hernia-sac dissection, mesh placement over the myopectineal orifice, and tack fixation to Cooper's ligament. The default model presents an indirect hernia on the right and direct plus femoral hernias on the left, allowing bilateral practice in a single session. The model can be adjusted for a more obese patient, larger or smaller defects, and more or less adherent peritoneum. The reusable anatomy lasts 20 to 30 uses, and the simulator costs roughly US$40 to build.[1]

Field Details
General Information A low-cost, modifiable laparoscopic inguinal hernia trainer for both TEP and TAPP repair. A reusable inguinal-anatomy assembly (styrene-foam bone, latex Penrose iliac vessels, feeding-tube cord and vas, putty nerves) carries a disposable sponge-and-fabric abdominal-wall model under a Press'n Seal peritoneum.[1]
Features and Basic Operation Supports both TEP and TAPP repair on a standard laparoscopic tower. The default model presents bilateral hernias — indirect on the right, direct plus femoral on the left. It can be adjusted for a more obese patient, larger or smaller defects, and more or less adherent peritoneum. Trainees carry out the full procedure from trocar placement through sac dissection, mesh placement, and tack fixation.[1]
Current Development Status Validated: built, tested, and shown valid for training and assessment in a face-validity pilot and a randomized controlled trial.[1][2]
Estimated Build Time and Cost Several hours to build the abdominal-wall model from raw materials; exact time not stated in source.[1], Approximately US$40 to build the reusable simulator.[1]
Specialized Tools and Equipment A standard operating-room laparoscopic tower, laparoscope, instruments, and trocars; a laparoscopic tacker for mesh fixation; and a plastic box-trainer to hold the model. All are operator-supplied and are not counted in the build cost.[1]
Version Not stated in source
Development Team Contact Information Yo Kurashima and colleagues, Steinberg-Bernstein Centre for Minimally Invasive Surgery and Innovation, McGill University, Montreal, Canada. Corresponding author: yo.kurashima@gmail.com.[1]

Tissues

Tissue Qty Material Cost Notes
Peritoneum 1 sheet over the model Plastic wrap (Press'n Seal) Part of the ~US$2 disposable set Press'n Seal clings to the sponge beneath it, so peeling the peritoneum off the abdominal wall feels as stubborn as a real preperitoneal dissection.[1]
Subcutaneous adipose tissue 1 sponge layer Sponge Part of the ~US$2 disposable set A softer sponge of appropriate thickness stands in for the subcutaneous fat; the source does not state a thickness.[1]
Abdominal-wall muscle (3 layers) 3 sponge layers Sponge wrapped in white stretchy fabric (fascia) Part of the ~US$2 disposable set Sponges of differing firmness give the distinct muscle planes the trainee retracts during trocar placement; the source does not state each plane's thickness.[1]
Fascia 1 fabric wrap per muscle layer White stretchy fabric Part of the ~US$2 disposable set The white stretchy fabric over each muscle sponge reads as the tough fascia the trainee must recognise and respect; fabric type is not stated in the source.[1]
Pubic bone and Cooper's ligament 1 piece (reusable) Styrene foam Part of the ~US$40 reusable set Firmer than the surrounding sponge, the foam lets the trainee find the pubic bone and Cooper's ligament by feel when placing tacks.[1]
External iliac artery and External iliac vein 2 (reusable) Latex Penrose drain Part of the ~US$40 reusable set Penrose drains match the calibre and suppleness of the iliac vessels and are tinted to read correctly on camera.[1]
Spermatic cord vessels and vas deferens 2 (reusable) Dobbhoff feeding tube Part of the ~US$40 reusable set The feeding tube's firm, rolling feel reproduces the vas deferens and survives repeated practice.[1]
Fine nerve branches Replaced when the model is refreshed White putty rolled into slender coils, glued to the pelvic wall Part of the ~US$2 disposable set Slender white-putty coils stand in for the fine nerve branches the trainee should preserve.[1]
Hernia sac and preperitoneal adhesions 1 per model (right indirect; left direct plus femoral) Plastic wrap (Press'n Seal) at the defect edge, with spray glue and Fun-Tak adherent putty Part of the ~US$2 disposable set The sac's adhesions make careless dissection tear the thin plastic film just as it would tear real peritoneum, so the trainee must work meticulously.[1]


Structural Parts

Part Name Qty Material Cost Notes
Plastic box-trainer 1 (operator-supplied) Standard laparoscopic box-trainer Operator-supplied; not part of the build cost A simple plastic box-trainer holds the abdominal-wall model during simulated laparoscopic dissection.[1]
Mesh-like fabric (12 cm × 10 cm) 1 per use Mesh-like fabric (brand not stated in source) Part of the ~US$2 disposable set At 12 cm × 10 cm, slightly smaller than the 15 cm × 10 cm clinical mesh because the model is smaller than an average adult abdomen.[1]
Laparoscopic tacks (consumable) Variable per fixation Operator-supplied laparoscopic tacks ~US$50 per use Tacks are the main consumable for mesh fixation.[1]
Laparoscopic tower, instruments, trocars, and tacker Operator-supplied Standard operating-room equipment Operator-supplied; not part of the build cost The simulator runs on a standard laparoscopic tower and instruments from the operating room.[1]


Build Instructions

The source paper describes the construction workflow at Kurashima 2011 p.2 col 2 to p.3 col 1.[1] The five build phases:

Phase 1: Construct the disposable multilayer abdominal-wall insert

  1. Cut sponges to thicknesses representing the subcutaneous adipose layer plus three abdominal-wall muscle layers. Specific thicknesses are not stated in the source paper.
  2. Wrap each muscle (sponge) layer with white stretchy fabric to create the fascia.
  3. Stack the layers in anatomical order — subcutaneous adipose first, then three muscle layers — to form the multilayer abdominal wall.
  4. Cover the stacked insert with Press'n Seal plastic wrap to create the peritoneum. The wrap should adhere to the underlying sponge so that peritoneum-from-abdominal-wall separation reproduces the in-vivo challenge.

Phase 2: Build the reusable inguinal anatomy

  1. Cut styrene foam to model the pubic bone and Cooper's ligament. The foam should retain a firmer texture than the abdominal-wall layers so that trainees can recognise the structures by feel during tack placement.
  2. Cut latex Penrose drains to the lengths needed for the external iliac artery and vein. Colour-tint each drain to match the source-described appearance.
  3. Cut Dobbhoff-type feeding tubes to the lengths needed for the cord vessels and the vas deferens. The feeding tube's small lumen and rolling tactile feel reproduce the firm rolling sensation of the vas during dissection.
  4. Roll white putty into slender coils to form the fine nerve branches. Putty type is not specified in the source paper.

Phase 3: Position the inguinal anatomy on the pelvic wall

  1. Arrange the styrene foam pubic bone and Cooper's ligament at the correct anatomic position on the pelvic wall.
  2. Position the latex Penrose drains in correct anatomical configuration for the external iliac artery and vein.
  3. Position the Dobbhoff feeding tubes for the cord vessels and vas deferens, separating them within the cord bundle so that the firm rolling vas is distinguishable from the suppler vessels.
  4. Attach the white-putty nerve-branch coils to the pelvic wall with glue.

Phase 4: Create the hernia defects

  1. Apply spray glue across the preperitoneal space to reproduce the diffuse peritoneum-to-cord adhesions encountered in vivo.
  2. Apply Fun-Tak adherent putty at the base of each hernia defect to create focal adhesions encouraging meticulous dissection.
  3. Cut the default hernia defects: indirect hernia opening on the right side; direct hernia plus femoral hernia openings on the left side. Modify defect size and the peritoneal adhesion density as needed to simulate a more obese patient, smaller or larger defects, or more or less adherent peritoneum.

Phase 5: Assemble into the box-trainer

  1. Place the multilayer insert into the plastic box-trainer with the inguinal anatomy assembly positioned beneath the abdominal-wall stack.
  2. Confirm trocar-placement target zones are accessible from above.
  3. Demonstrate the build with a TAPP or TEP simulated repair using the laparoscopic tower and standard instruments, including reduction of the hernia sac, mesh placement over the myopectineal orifice, and tack fixation to Cooper's ligament.

For learner-facing setup, operation, reset between learners, and stepwise procedural instruction (TAPP and TEP techniques), refer to the corresponding SELF Module for laparoscopic inguinal hernia repair training and to Kurashima et al. 2011 and 2014.



References

[1][2]

  1. ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 1.12 1.13 1.14 1.15 1.16 1.17 1.18 1.19 1.20 1.21 1.22 1.23 1.24 1.25 Kurashima Y, Feldman L, Al-Sabah S, Kaneva P, Fried G, Vassiliou M (2011). "A novel low-cost simulator for laparoscopic inguinal hernia repair." Surgical Innovation 18(2):171–175. DOI: 10.1177/1553350610395949. PMID: 21307013. © The Author(s) 2011, SAGE Publications. Unrestricted educational grant from Covidien Canada.
  2. ↑ 2.0 2.1 Kurashima Y, Feldman LS, Kaneva PA, Fried GM, Bergman S, Demyttenaere SV, Li C, Vassiliou MC (2014). "Simulation-based training improves the operative performance of totally extraperitoneal (TEP) laparoscopic inguinal hernia repair: a prospective randomized controlled trial." Surgical Endoscopy 28(3):783–788. DOI: 10.1007/s00464-013-3241-8. PMID: 24149850. © Springer Science+Business Media New York 2013. IRB approval McGill A07-M71-10B. Yo Kurashima salary funded by an unrestricted Covidien grant during the study period.




Simulator data
Alternative names McGill Laparoscopic Inguinal Hernia Simulator (MLIHS)



Page data
Keywords laparoscopic inguinal hernia repair, LIHR, TEP, TAPP, totally extraperitoneal, transabdominal preperitoneal, McGill, MLIHS, Kurashima, Penrose drain, Dobbhoff feeding tube, Press'n Seal, styrene foam, Fun-Tak, Cooper's ligament, triangle of doom, mesh fixation, hernia simulator
SDG
Authors Arturopelayo
License CC-BY-SA-4.0
Language English (en)
Related 0 subpages, 7 pages link here
Views 12 page views (analytics)
Created May 13, 2026 by Arturo Pelayo
Last edit May 26, 2026 by Arturo Pelayo
Cite as Arturopelayo (2026). "TissueDB/Simulators/Laparoscopic Inguinal Hernia Repair Simulator (Kurashima)". Appropedia. Retrieved June 4, 2026.
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