Available online 16 May 2023

Author links open overlay panel, , , , OBJECTIVE

The objective of this paper is to describe the techniques and process of developing and testing a take-home surgical anastomosis simulation model.

DESIGN

Through an iterative process, a simulation model was customized and designed to target specific skill development and performance objectives that focused on anastomotic techniques in thoracic surgery and consist of 3D printed and silicone molded components. Various manufacturing techniques such as silicone dip spin coating and injection molding have been described in this paper and explored as part of the research and development process. The final prototype is a low-cost, take-home model with reusable and replaceable components.

SETTING

The study took place at a single-center quaternary care university-affiliated hospital.

PARTICIPANTS

The participants included in the model testing were 10 senior thoracic surgery trainees who completed an in-person training session held during an annual hands- on thoracic surgery simulation course. Feedback was then collected in the form of an evaluation of the model from participants.

RESULTS

All 10 participants had an opportunity to test the model and complete at least 1 pulmonary artery and bronchial anastomosis. The overall experience was rated highly, with minor feedback provided regarding the set- up and fidelity of the materials used for the anastomoses. Overall, the trainees agreed that the model was suitable for teaching advanced anastomotic techniques and expressed an interest in being able to use this model to practice skill development.

CONCLUSIONS

Developed simulation model can be easily reduced, with customized components that accurately simulate real-life vascular and bronchial components suitable for training of anastomoses technique amongst senior thoracic surgery trainees.

Section snippetsINTRODUCTION

Traditional surgical education is changing at a rapid pace. This shift has been influenced by the widespread adoption and availability of rapid manufacturing methods, such as 3D printing, and ever-evolving analytical methods for data acquisition and processing. Since the declaration of the COVID-19 global pandemic, the modern approach to on-site skill development has had to evolve to accommodate limited access to training due to the risk of exposure and scarcity of resources. In many ways,

Model Preparation

The design and manufacturing process for the anastomosis simulation module was broken down into 3 components. These include: 1) design and assembly of the mounting box with multifunctional mounting plates to adjust the complexity of the anastomosis model, 2) testing and comparison of materials used to mimic vascular anatomy and physical properties, 3) design, manufacturing, and assembly of a silicone bronchial segment (Fig. 1).

Model Components: Mounting Box

In designing this model for take-home practice, the first component

Results

All 10 participants had an opportunity to try out the module and complete at least 1 pulmonary artery and bronchial anastomosis. The overall experience was rated highly with minor feedback provided regarding the set-up and material qualities. Overall, the trainees agreed that the model was suitable for teaching advanced anastomosis techniques and expressed interest in being able to use this model to practice skill development remotely. The Penrose material used to simulate pulmonary artery was

COMMENTARY

The importance of teaching technical skills outside of the operating room has been clearly recognized as a priority in medical education, as is evidenced by the multitude of literature published on this topic. The education of very senior learners, training in a surgical subspeciality after being certified as a competent surgeon, has been focused on much less than the training of junior learners.8, 9, 10 For the junior trainees, a basic low-fidelity model with very little similarity to the

LIMITATIONS

Further analysis and testing need to be performed to fully assess the feasibility and function of the proposed simulation module. One limitation of our simulation module pertains to the materials used, such as the Penrose drains. The lack of fidelity of the drains was perceived by the trainees during the suturing practice. While the suture drag noted with use of the Penrose can be addressed with light coating of the suture with mineral oil or petroleum jelly, we believe that a higher fidelity

FUTURE DIRECTIONS

Our current study is a pilot that we performed to iteratively develop high-fidelity simulation models for senior trainees in thoracic surgery. We focused on the techniques and methods for model development and collection of user experience feedback to ensure its feasibility for future studies. In a follow-up study we plan to establish the validity of the model for anastomosis training using participants of various skill levels at multiple centers.

CONCLUSIONS

The simulation box that we have developed has been shown to be easily reproducible, with models that accurately simulate real-life vascular and bronchial anastomoses for senior trainees. This simulation box may become an important method of training technical skills outside of the operating room for all levels of learners, with increasing task-complexity and possibility of standardized assessment.

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© 2023 Published by Elsevier Inc. on behalf of Association of Program Directors in Surgery.