New training model using chickens intestine for pediatric intestinal anastomosis

Surgical Simulation of Posterior Sagittal Anorectoplasty for Rectovestibular Fistula: Low-Cost High-Fidelity Animal-Tissue Model

PURPOSE

To provide a high-fidelity, animal tissue-based model for the advanced surgical simulation of a Posterior Sagittal Anorectoplasty (PSARP) for rectovestibular fistula in anorectal malformation (ARM).

MATERIALS AND METHODS

A chicken cadaver was used to assess the feasibility of simulating a PSARP for rectovestibular fistula in ARM. No modification was required to implement the surgical simulation.

RESULTS

A detailed description of the high-fidelity surgical simulation model is provided. The PSARP can be simulated while providing realistic anatomy (e.g. common wall between rectovestibular fistula and vagina), adequate rectal size, location and placement of the rectovestibular fistula, and proximity to the vagina. Haptic conditions of the tissue resemble human tissue and operative conditions as well.

DISCUSSION

Concerning the decreased exposure of index cases of pediatric surgical trainees and pediatric surgeons in practice, simulation-based training can provide means to acquire or maintain the necessary skills to perform complex surgical procedures [1-5] Surgical simulation models for ARM are limited. Few low-cost trainers are available with predominant artificial and mostly unrealistic tissue [6-8] Animal models have the advantage of realistic multilayer tissue haptic feedback [6].

CONCLUSION

We provide a low-cost, high-fidelity model for correcting a rectovestibular fistula in a child with ARM, a complex operative procedure with low incidence but high-stake outcomes. The described tissue model utilizing the chicken cloaca anatomy provides a high-fidelity model for operative correction of rectovestibular ARM. For simulation purposes in the treatment of ARM, this model appears to be promising in terms of providing realistic pathology and haptic feedback in pediatric dimensions.

LEVEL OF EVIDENCE

V.

The development and clinical efficacy of simulation training of open duct-to-mucosa pancreaticojejunostomy using pancreas and intestine silicone models

Purpose

As pancreaticojejunostomy (PJ) is a challenging anastomosis, an education program is needed to train young surgeons to perform PJ. This study evaluated the effects of simulation-based training of open PJ using pancreas and intestine silicone models.

Methods

Five videos pancreatobiliary clinical fellows who did not perform PJ participated in this study. After watching the master video created by a senior pancreatobiliary surgeon, each trainee performed the PJ using silicone models and recorded them 10 times using a video camera. Of these videos, 5 were randomly duplicated due to the validation of the scoring system. The scoring system developed consisted of 20 scores. Three pancreatobiliary professors scored their performance by watching videos.

Results

The mean procedure time of the 5 trainees was 25.4 minutes (range, 23.5–27.3 minutes) in the first video and 15.8 minutes (range, 13.8–19.1 minutes) in the 10th video. The mean score was 12.6 (range, 5–19) and 18.3 (range, 15–20) in the first and 10th videos, respectively. The scores were similar among the duplicated videos for each supervisor.

Conclusion

This education system would help pancreatobiliary trainees to overcome learning curves efficiently without ethical issues related to animal models or direct practice to human patients.

Face and construct validity assessment of training models for intestinal anastomosis in low-birth-weight infants

PURPOSE

It is difficult to perform intestinal anastomosis in low-birth-weight infants because the intestinal diameter is small and the discrepancy in diameter of the proximal and distal intestines is often large, but there has been no optimal-sized training model. Therefore, we developed a new intestinal anastomosis training model that imitated the size of the intestine in low-birth-weight infants, and evaluated its face and construct validity.

METHODS

Two intestinal models were developed with crossMedical, Inc. using a hydrophilic acrylic material (wet model) or a polyurethane soft resin (dry model). The inner diameter of the simulated intestinal tract was 15 mm on the oral end and 6 mm on the anal end. Thirteen pediatric surgeons performed anastomosis and responded to the questionnaire.

RESULTS

In the questionnaire, the wet model had significantly higher scores than the dry model in "appearance", "softness" and "usefulness for training". In the anastomotic results of the wet model, the anastomosis leak pressure was significantly correlated with the number of intestinal anastomotic experiences in low-birth-weight infants (correlation coefficient = 0.64, P = 0.035).

CONCLUSIONS

The wet-type intestinal anastomosis model showed good face validity. Its leak pressure had a significant correlation with clinical experience; thus, construct validity was demonstrated.

Development and validation of the objective assessment of robotic suturing and knot tying skills for chicken anastomotic model

BACKGROUND

To improve patient safety, there is an imperative to develop objective performance metrics for basic surgical skills training in robotic surgery.

OBJECTIVE

To develop and validate (face, content, and construct) the performance metrics for robotic suturing and knot tying, using a chicken anastomotic model.

DESIGN, SETTING AND PARTICIPANTS

Study 1: In a procedure characterization, we developed the performance metrics (i.e., procedure steps, errors, and critical errors) for robotic suturing and knot tying, using a chicken anastomotic model. In a modified Delphi panel of 13 experts from four EU countries, we achieved 100% consensus on the five steps, 18 errors and four critical errors (CE) of the task. Study 2: Ten experienced surgeons and nine novice urology surgeons performed the robotic suturing and knot tying chicken anastomotic task. The mean inter-rater reliability for the assessments by two experienced robotic surgeons was 0.92 (95% CI, 0.9-0.95). Novices took 18.5 min to complete the task and experts took 8.2 min. (p = 0.00001) and made 74% more objectively assessed performance errors than the experts (p = 0.000343).

CONCLUSIONS

We demonstrated face, content, and construct validity for a standard and replicable basic anastomotic robotic suturing and knot tying task on a chicken model. Validated, objective, and transparent performance metrics of a robotic surgical suturing and knot tying tasks are imperative for effective and quality assured surgical training.

Novel Porcine Kidney-Based Microsurgery Training Model for Developing Basic to Advanced Microsurgical Skills

BACKGROUND

 Microsurgery training is critical to the practice of microvascular procedures in many surgical areas. However, even simple procedures require different levels of complex skills. Therefore, simulation-based surgical training, mainly in the area of vascular anastomosis, is of great importance. In this paper, we present a new microsurgery training model for the development of basic to advanced microsurgical skills.

METHODS

 Porcine kidneys were purchased from a legal butchery slaughterhouse. First, kidneys were washed with water to remove blood and clots inside vessels. Then, dissection was performed throughout the vascular pedicle from the renal arteries to the segmentary branches. Finally, the longitudinal sectioning of the kidney parenchyma was performed to expose the vessels necessary for training. Sixty end-to-end anastomoses were performed. Specific instruments and materials were used to perform anastomoses and dissections with magnification by a video system. We evaluated the diameter of vessels, time to perform anastomosis, and patency of anastomosis.

RESULTS

 There was no great anatomical variation among the porcine kidneys. The total length for dissection training was 25.80 ± 7.44 cm using the arterial and venous vessel. The average time to perform arterial anastomoses was 23.79 ± 4.55 minutes. For vessel diameters of ≤ 3, 4 to 6, and 7 to 10 mm, the average procedure times were 27.68 ± 3.39, 22.92 ± 4.12, and 20.77 ± 3.44 minutes, respectively. Regarding venous anastomosis, the average duration of the procedure was 26.17 ± 4.80 minutes, including durations of 31.61 ± 3.86, 25.66 ± 4.19, and 21.24 ± 3.79 minutes for vessel diameters of ≤ 7, 8 to 10, and >10 mm, respectively. Positive patency was achieved in all surgeries.

CONCLUSION

 The porcine kidney provides an inexpensive and convenient biological model for modeling microanastomosis with high fidelity to vascular structures.