K. M. Bell1, B. Wise1, C. Kwan1, A. Witt1, C. M. Pugh1 1University Of Wisconsin,Surgery,Madison, WI, USA
Introduction:
Surgical residency programs have relied on cadaveric animal tissue, to practice and teach surgical procedures and techniques. The drawbacks to using animal tissue are short shelf life, sporadic availability, and costs of manpower and management needs. For training purposes, commercial synthetic tissue and virtual reality simulators are also used, but can be very expensive. The aim of this study is to determine if our fabricated silicone-based bowels are valuable for surgical education and competitive with commercial products. We hypothesize that silicone-based bowels can be a useful training tool for general surgery residents and can be more cost effective than commercial products.
Methods:
General Surgery residents (N=6) evaluated three synthetic bowel prototypes. Two synthetic small bowels (Model B and C) were fabricated using cellulose fiber sheets, cotton fiber mesh, and silicone rubbers in different concentrations, to replicate the serosa, muscularis and mucosa. Cost for these models is $5. A third, commercial small bowel was purchased (Model A) for $60. Participants blindly selected what they felt to be most realistic from a covered basin and those choices were documented. Next, participants performed a suturing task on all three samples and evaluated the bowel’s realism using a Likert based survey. Favorable responses were denoted as ‘average’, ‘accurate’, or ‘highly accurate’. Unfavorable responses included ‘highly inaccurate’ and ‘inaccurate’.
Results:
83% of participants had previously used synthetic bowel for learning purposes, and 50% of participants reported performing 1 to 5 bowel Enterotomy repairs per month in the operating room. During the blind identification test, 66% of participants selected one of the silicone-based rubber bowels (B or C), over the commercial bowel (A) as feeling the most realistic. Model A tended to have more favorable responses regarding mechanical functionality of the bowel, with ten-out-of-ten of the favorable survey responses. Model B had seven-out of ten favorable responses, and Model C had a five-out-of-ten favorable responses. All the participants answered ‘accurate’ or ‘highly accurate’ in response to the survey statements confirming that simulation could highlight the strengths or weaknesses in their technical skill.
Conclusion:
The silicone-based bowels, models B and C, were more likely to be selected in the blind identification test. When the favorable properties of model B and C are combined, we will be able to produce a prototype that is financially, tactically, and mechanically competitive to the current commercial products. This study shows that silicone based rubber bowels have value for surgical education, and that with advancement; they can be a viable replacement to cadaveric animal tissue, commercial prototypes, and other, more costly training products.