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Less is more: creation and validation of a novel, affordable suturing simulator for anorectal surgery

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Abstract

Background

Duty hour restrictions have increased the role of simulation in surgical education. A simulation that recreates the unique visual, anatomic, and ergonomic challenges of anorectal surgery has yet to be described. The aim of this study was to develop a low-cost, low-fidelity anorectal surgery simulator and provide validity evidence for the model.

Methods

A novel, low-fidelity simulator was constructed, and anorectal surgery workshops were implemented for general surgery interns at a single institution. Face and content validity were assessed with separate questionnaires using a 5-point Likert scale. Participants performed a simulated hemorrhoid excision with longitudinal wound closure, and transverse wound closure. Time-to-task completion and quality of suturing/knot tying were evaluated by a blinded observer to assess construct validity.

Results

Material cost was US $11 per simulator. We recruited 20 first-year surgery residents (novices) and 4 practicing colorectal surgeons (experts), and conducted 3 workshops in 2014–2016. All face and content validity measures achieved a median score greater than 4 (range 4.0–5.0). Time-to-task completion was significantly lower in the expert cohort (hemorrhoid excision with longitudinal wound closure: 195 vs. 477 s and transverse closure: 79 vs. 192 s, p < 0.001 for both). Suturing and knot-tying scores were significantly higher in the expert cohort for both tasks (p < 0.05 for all comparisons).

Conclusions

Our low-fidelity, low-cost anorectal surgery model demonstrated evidence of face, content, and construct validity. We believe that this simulator could be a useful instrument in the education of junior surgical trainees and will allow residents to obtain proficiency in anorectal suturing tasks in conjunction with traditional surgical training.

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References

  1. Ahmed N, Devitt KS, Keshet I et al (2014) A systematic review of the effects of resident duty hour restrictions in surgery: impact on resident wellness, training, and patient outcomes. Ann Surg 259(6):1041–1053. https://doi.org/10.1097/SLA.0000000000000595

    Article  PubMed  Google Scholar 

  2. Bates T, Cecil E, Greene I (2007) The effect of the EWTN on training in general surgery: an analysis of electronic logbook records. Ann R Coll Surg Engl (Suppl) 89:106–109

    Article  Google Scholar 

  3. Breen JK, Hogan AM, Mealy K (2013) The Detrimental Impact of the Implementation of the European Working Time Directive (EWTD) on Surgical Senior House Office (SHO) Operative Experience. Ir J Med Sci 182(3):383–387. https://doi.org/10.1007/s11845-012-0894-6

    Article  CAS  PubMed  Google Scholar 

  4. Drolet BC, Sangisetty S, Tracy TF et al (2013) Surgical residents’ perceptions of 2011 accreditation council for graduate medical education duty hour regulations. JAMA Surg 148(5):427–433. https://doi.org/10.1001/jamasurg.2013.169

    Article  PubMed  Google Scholar 

  5. Cortez AR, Katsaros GD, Dhar VK et al (2018) Narrowing of the surgical resident operative experience: a 27-year analysis of national ACGME case logs. Surgery 164:577–582

    Article  PubMed  Google Scholar 

  6. Schwartz SI, Galante J, Kaji A et al (2013) Effect of the 16-hour work limit on general surgery intern operative case volume: a multi-institutional study. JAMA Surg 148(9):829–833. https://doi.org/10.1001/jamasurg.2013.2677

    Article  PubMed  Google Scholar 

  7. Antiel RM, Reed DA, Van Arendonk KJ et al (2013) Effects of duty hour restrictions on core competencies, education, quality of life, and burnout among general surgery interns. JAMA Surg 148(5):448–455. https://doi.org/10.1001/jamasurg.2013.1368

    Article  PubMed  Google Scholar 

  8. Napolitano LM, Savarise M, Paramo JC et al (2014) Are general surgery residents ready to practice? A survey of the american college of surgeons board of governors and young fellows association. J Am Coll Surg 218(5):1063–1072.e31. https://doi.org/10.1016/j.jamcollsurg.2014.02.001

    Article  PubMed  Google Scholar 

  9. Mattar SG, Alseidi AA, Jones DB et al (2013) General surgery residency inadequately prepares trainees for fellowship: results of a survey of fellowship program directors. Ann Surg 258(3):440–449. https://doi.org/10.1097/SLA.0000000000000476

    Article  PubMed  Google Scholar 

  10. Society of American Gastrointestinal and Endoscopic Surgeons (2018) Fundamentals of laparoscopic surgery. https://www.flsprogram.org/. Accessed 22 Jul 2018

  11. Society of American Gastrointestinal and Endoscopic Surgeons (2018) Fundamentals of endoscopic surgery. https://www.fesprogram.org/. Accessed 22 Jul 2018

  12. de Montbrun SL, Roberts PL, Lowry AC et al (2013) A novel approach to assessing technical competence of colorectal surgery residents: the development and evaluation of the colorectal objective structured assessment of technical skill (COSATS). Ann Surg 258(6):1001–1006. https://doi.org/10.1097/SLA.0b013e31829b32b8

    Article  PubMed  Google Scholar 

  13. Accreditation Council for Graduate Medical Education (2018) ACGME Program Requirements for Graduate Medical Education in General Surgery Section II.D.2. (2017, September 24). http://www.acgme.org/Portals/0PFAssets/ProgramRequirements/440GeneralSurgery2018.pdf?ver=2017-10-03-110315-270. Accessed 22 Jul 2018

  14. Gaitanidis A, Simopoulos C, Pitiakoudis M (2018) What to consider when designing a laparoscopic colorectal training curriculum: a review of the literature. Tech Coloproctol 2018(22):151–160. https://doi.org/10.1007/s10151-018-1760-y

    Article  Google Scholar 

  15. Martin Perez B, Bennis H, Lacy AM (2018) Virtual reality simulation for surgery: from video games to transanal total mesorectal excision. Tech Coloproctol 2018(22):5–6. https://doi.org/10.1007/s10151-017-1738-1

    Article  Google Scholar 

  16. Holden RB (2010) “Face validity”. In: Weiner IB, Craighead WE (eds) The corsini encyclopedia of psychology (4th ed). Wiley, Hoboken, pp 637–638. (ISBN 978-0-470-17024-3)

  17. Schout BM, Hendrikx AJ, Scheele F et al (2010) Validation and implementation of surgical simulators: a critical review of present, past, and future. Surg Endosc 24(3):536–546. https://doi.org/10.1007/s00464-009-0634-9

    Article  CAS  PubMed  Google Scholar 

  18. Dobson HD, Pearl RK, Orsay CP et al (2003) Virtual reality: new method of teaching anorectal and pelvic floor anatomy. Dis Colon Rectum 46(3):349–352. https://doi.org/10.1097/01.DCR.0000054639.29160.9E

    Article  PubMed  Google Scholar 

  19. Illston JD, Ballard AC, Ellington DR et al (2017) Modified beef tongue model for fourth-degree laceration repair simulation. Obstet Gynecol 129(3):491–496. https://doi.org/10.1097/AOG.0000000000001908

    Article  PubMed  Google Scholar 

  20. Dancz CE, Sun V, Moon HB et al (2014) Comparison of 2 simulation models for teaching obstetric anal sphincter repair. Simul Healthc 9(5):325–330. https://doi.org/10.1097/SIH.0000000000000043

    Article  PubMed  Google Scholar 

  21. Melich G, Pai A, Shoela R et al (2018) Rectal dissection simulator for da vinci surgery: details of simulator manufacturing with evidence of construct, face, and content validity. Dis Colon Rectum 61(4):514–519. https://doi.org/10.1097/DCR.0000000000001044

    Article  PubMed  Google Scholar 

  22. Koch AD, Ekkelenkamp VE, Haringsma J et al (2015) Simulated colonoscopy training leads to improved performance during patient-based assessment. Gastrointest Endosc 81(3):630–636. https://doi.org/10.1016/j.gie.2014.09.014

    Article  PubMed  Google Scholar 

  23. Seymour NE, Gallagher AG, Roman SA, OBrien MK, Bansal VK, Andersen DK, Satava RM (2002) Virtual reality training improves operating room performance, results of a randomized, double-blinded study. Ann Surg 236(4):458–464. https://doi.org/10.1097/01.sla.0000028969.51489.b4

    Article  PubMed  PubMed Central  Google Scholar 

  24. Hashimoto DA, Sirimanna P, Gomez ED et al (2015) Deliberate practice enhances quality of laparoscopic surgical performance in a randomized controlled trial: from arrested development to expert performance. Surg Endosc 29(11):3154–3162. https://doi.org/10.1007/s00464-014-4042-4

    Article  PubMed  Google Scholar 

  25. Korndorffer JR Jr, Kasten SJ, Downing SM (2010) A call for the utilization of consensus standards in the surgical education literature. Am J Surg 199(1):99–104. https://doi.org/10.1016/j.amjsurg.2009.08.018

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, University of Nebraska Medical Center, 620 S 42nd St and Emile St, Omaha, NE, 68198, USA

    S. J. Langenfeld, M. A. Fuglestad, J. S. Thompson & C. Are

  2. Department of Surgery, Keck School of Medicine, University of Southern California, 1975 Zonal Ave, Los Angeles, CA, 90033, USA

    K. G. Cologne

  3. Department of Colorectal Surgery, Department of Surgery, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH, 44195, USA

    S. R. Steele

Authors
  1. S. J. Langenfeld
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  2. M. A. Fuglestad
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  3. K. G. Cologne
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  4. J. S. Thompson
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  5. C. Are
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  6. S. R. Steele
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Contributions

SJL: concept design, data acquisition, analysis, manuscript drafting, manuscript revision, final approval, and agreement for accountability for all aspects of the work. MAF: analysis, manuscript drafting, manuscript revision, final approval, and agreement for accountability for all aspects of the work. KGC: analysis, manuscript drafting, manuscript revision, final approval, and agreement for accountability for all aspects of the work. JST: analysis, manuscript drafting, manuscript revision, final approval, and agreement for accountability for all aspects of the work. CA: concept design, data acquisition, analysis, manuscript drafting, manuscript revision, final approval, and agreement for accountability for all aspects of the work. SRS: analysis, manuscript drafting, manuscript revision, final approval, and agreement for accountability for all aspects of the work.

Corresponding author

Correspondence to S. J. Langenfeld.

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The authors declare that they have no conflict of interest.

Ethical approval

This study was reviewed and approved by the University of Nebraska Medical Center's Institutional Review Board.

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Written informed consent was obtained by all participants prior to experimentation.

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Langenfeld, S.J., Fuglestad, M.A., Cologne, K.G. et al. Less is more: creation and validation of a novel, affordable suturing simulator for anorectal surgery. Tech Coloproctol 23, 1057–1064 (2019). https://doi.org/10.1007/s10151-019-02091-x

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  • DOI: https://doi.org/10.1007/s10151-019-02091-x

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