Limitations
hernia
POSTOPERATIVE COMPLICATIONS
As the TS module was only available in English, this could be seen as a limitation to the study. Some of the senior physicians noted differences in terminology between German and English and showed struggles in responding to the MC questions as a result. Also, the version of TAPP taught by TS differed slightly in operating technique compared to the Heidelberg standard. This was highlighted by most of the surgeons (residents and senior physicians) as it led them to answer some test questions falsely because they disagreed with the operating method. Nevertheless, every participant performed the learning mode on TS for both phases before performing on test mode, so they could familiarize themselves with the terminology. Additionally, comparing the transferability of laparoscopic skills between the inguinal hernia modules on TS and the VR trainer showed limitations in this study as the module on the VR trainer taught and tested skills on anatomy, incision, and peritoneal dissection, but not mesh placement, as this component was still under development at the time this study was conducted. Mesh placement forms part of the TAPP procedure and was taught and tested on TS. Furthermore, rather than talking about skill transfer from TS to the VR trainer, the results of this study should be interpreted as showing the additional benefit of using Serious Games in combination with VR to increase the performance on the VR trainer regarding anatomical knowledge.The transferability to clinical performance was not assessed, as this study could not assess the actual performance in real patients. Nevertheless, our study enabled the assessment of the value of Serious Gaming and VR in current training curricula for MIS”. Transferability of simulation training to the clinical praxis has been demonstrated previously; studies have shown the benefit of simulation-based training outside the OR for surgical performance, as the skills acquired during training helped to improve intraoperative performance and enhance patient outcomes. In the training of laparoscopic TEP inguinal hernia repair, simulation-based training has been shown to improve trainee performance, decrease operative time, and reduce intra- and postoperative complications as well as overnight stays [