Development and assessment of an ex vivo simulated model for intracorporeal anastomosis training in laparoscopic right hemicolectomy

Abstract

Introduction: Although intracorporeal anastomosis has demonstrated clinical benefits over extracorporeal anastomosis in laparoscopic right hemicolectomy, its application has been limited due to its technical difficulty and longer learning curve. The present study aims to develop and evaluate a simulated model to train this procedure.

Materials and Method: An ex vivo tissue model was developed with porcine colon and bovine small bowel mounted in a laparoscopic simulator. This was subsequently modified based on semistructured interviews to experts until the final model was achieved. To evaluate appearance and reaction to the model, the participants performed an ileocolic mechanical anastomosis in the model and answered a survey.

Results: Twelve subjects participated. Four colorectal surgeons, 4 colorectal surgery fellows, 2 residents of general surgery, 1 general surgeon and 1 upper digestive surgeon. Of all subjects, 91.6%, 83.3% and 75% deemed ergonomics achieved, the use of instruments, and the anatomical relationship between structures as similar to reality, respectively. All participants deemed the model useful to train laparoscopic manual suturing, while 91.6% and 83.3% of them considered it useful to train enterotomies and the use of an endostapler, respectively. All declared that the model allows to understand the proposed technique.

Conclusion: This model would be useful to train critical skills to perform an intracorporeal anastomosis in laparoscopic right hemicolectomy. Its incorporation into an advanced simulated laparoscopy training program could help shorten the learning curve of this procedure.