Characterization of technical skill progress in a standardized rabbit model for training in laparoscopic duodenal atresia repair

Abstract

Background Laboratory skills training is an essential step before conducting minimally invasive surgery in clinical practice. Our main aim was to develop an animal model for training in clinically highly challenging laparoscopic duodenal atresia repair that could be useful in establishing a minimum number of repetitions to indicate safe performance of similar interventions on humans. Materials and methods A rabbit model of laparoscopic duodenum atresia surgery involving a diamond-shaped duodeno-duodenostomy was designed. This approach was tested in two groups of surgeons: in a beginner group without any previous clinical laparoscopic experience (but having undergone previous standardized dry-lab training, n = 8) and in an advanced group comprising pediatric surgery fellows with previous clinical experience of laparoscopy (n = 7). Each participant performed eight interventions. Surgical time, expert assessment using the Global Operative Assessment of Laparoscopic Skills (GOALS) score, anastomosis quality (leakage) and results from participant feedback questionnaires were analyzed. Results Participants in both groups successfully completed all eight surgeries. The surgical time gradually improved in both groups, but it was typically shorter in the advanced group than in the beginner group. The leakage rate was significantly lower in the advanced group in the first two interventions, and it reached its optimal level after five operations in both groups. The GOALS and participant feedback scores showed gradual increases, evident even after the fifth surgery. Conclusions Our data confirm the feasibility of this advanced pediatric laparoscopic model. Surgical time, anastomosis quality, GOALS score and self-assessment parameters adequately quantify technical improvement among the participants. Anastomosis quality reaches its optimal value after the fifth operation even in novice, but uniformly trained surgeons. A minimum number of wet-lab operations can be determined before surgery can be safely conducted in a clinical setting, where the development of further non-technical skills is also required.

Advances in Pediatric Surgery Simulation-Based Training

“…Live tissues have the obvious benefits of tactile and visual fidelity during handling [29]. Trainees are able to practice basic surgery skills and more complex procedures such as laparoscopic duodenal atresia and diaphragmatic hernia repair [28,30,31]. On the other hand, cadaveric tissue and the vivisection of animals can be costly and logistically difficult to store and curate [27,32].…”

“…The availability of vivisection varies based on the institution's association with nearby veterinarian schools. Internationally, vivisection with porcine and smaller animal labs for laparoscopic skill development has been performed in pediatric surgery programs [30,34]. In addition to emulating a small operative internal cavity space, anesthetized animals can be monitored on the operating room table as part of a high-fidelity simulation experience [34].…”

“…Engineers and trained technicians can therefore develop products to meet the haptic and tactile needs of surgeons (Figure 1). A hybrid of 3D printing and cadaver tissue has even been used [30].…”