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A New 3D-Printed LNF Training Model
2.3. Training curriculum interrupted suture 2–3 times to close bilateral diaphragmatic

Operators were required to finish following steps: crura with 2-0 non-absorbable Ethilon thread to close hiatal
(i) Operators cut open silicone gel layer around the hernia (Figure 2D-E); (iii) operators flatten the mesh and
esophagus using ultrasonic scalpel to establish posterior 6–8 suture on due spot for fixation of mesh on diaphragm
esophagus tunnel (Figure 2B); (ii) operators perform (Figure 2F-G); (iv) in Nissen fundoplication, operators

Table 1. General information of participants
Experimental group Control group P-value
Age 28.13 29 >0.9999
Gender M (7/8), F (1/8) M (7/8), F (1/8)
Hand dominance R (8/8), L (0/8) R (8/8), L (0/8)
PGY level PGY-3 8/8 PGY-3 8/8
Average no. of basic laparoscopic procedures 95.63 99.38 >0.9999
Average no. of intermediate laparoscopic procedures 0.25 0.375 0.5598
Average no. of advanced laparoscopic procedures 0 0
Average no. of laparoscopic bariatric procedures 0 0
Box training experience Y (8/8) N (0/8) Y (8/8) N (0/8)
VR experience Y (0/8) N (8/8) Y (0/8) N (8/8)
3D printing model experience Y (0/8) N (8/8) Y (0/8) N (8/8)
Ex vitro animal experience Y (0/8) N (8/8) Y (0/8) N (8/8)
Live animal experience Y (0/8) N (8/8) Y (0/8) N (8/8)
Average no. of laparoscopic cholecystectomy (LC) 42.38 46.88 0.3113
Psychomotor skills (OSATS SCORE) 23.00 22.13 >0.9999
Average knowledge test score 8.125 8.625 >0.9999
M: Male; F: Female; Y: Yes; N: No; VR: Virtual reality.

A B C

D E F

G H I

Figure 2. Model Nissen fundoplication procedure. (A) An overview of model under laparoscopy on simulation platform. (B) Established
posterior esophagus tunnel. (C) Interrupted suture on hiatal hernia. (D) Enclosed hiatal hernia. (E) A step of placing mesh and fixation suture
on diaphragm. (F) Fixed mesh. (G) Fundoplication through shoeshine maneuver. (H) Making a wrap using interrupted suture. (I) Forming
a wrap.
64 International Journal of Bioprinting (2022)–Volume 8, Issue 2