Building and training a low-cost and portable vascular anastomosis simulator: Initial experience of a surgical resident

Abstract

Introduction and objectivesSeveral factors have caused the operating room to no longer be the ideal place for early surgical training, forcing the search for more effective options for simulation-based surgical learning. The objective of our study was to design and build a home-made proposal for a vascular anastomosis simulator for surgical training. MethodsDescriptive, preliminary, observational, analytical, and prospective study. The study was divided into two phases, the simulator construction with low-cost common materials (9.75$), and its operative evaluation with the Objective Structured Assessment of Technical Skills (OSATS-Modified). The study subject was a cardiothoracic surgery junior resident (postgraduate year two, PGY-2) who used the simulator and was evaluated through recorded sessions in 2 consecutive 3-month periods (first period, FP vs. second period, SP) by a senior surgeon. The acquisition of operative skills in the creation of end-to-side (E-T-S), side-to-side (S-T-S), end-to-end (E-T-E) vascular anastomoses were evaluated. ResultsThere were 273 sessions with a total of 4904min of simulation training between the three anastomosis modalities. A significant improvement was identified in the final OSATS-Modified scores (FP vs. SP) in the use of the Castroviejo needle holder, needle angles, and needle transfer in the E-T-S anastomosis (p<.05); graft orientation, appropriate spacing, use of Castroviejo needle holder, and the needle angles in the S-T-S (p<.05), and in the use of the Castroviejo needle holder, and needle transfer in the E-T-E (p<.05). Significant improvement was reported in E-T-S anastomosis time and S-T-S (p<.05). ConclusionsOur home-made portable prototype has proven to be very efficient in improving operational skills on a smaller scale; however, our findings need to be extrapolated to a larger population of surgical residents. Current evidence suggests that skills acquired through simulation-based training are transferred and positively impact the surgical environment.