Low-Cost Simulation Model for Training MIS Repair of Duodenal Atresia Combined with Telementoring Technology: Initial Assessment

Abstract

Introduction: The use of minimal invasive surgery (MIS) simulation models has been included into our residency program curricula and hands-on courses since 2013. We have previously presented our low-cost tracheoesophageal fistula esophageal atresia simulation model for training in IPEG 2013. The Society of American Gastrointestinal and Endoscopic Surgeons describes telementoring as a relationship, facilitated by telecommunication technology, in which an expert provides guidance to a less experienced learner from a remote location. MIS procedures are an ideal platform for real-time transmission and thus apply telementoring for surgery. We started a project to look at the efficacy of telementoring starting with simulation. Aim: The aim of this 5 minute video is to present a low-cost simulation model for training MIS repair of duodenal atresia (DA) and our first steps with combining telementoring technology. Material and Methods: The base model was introduced into the abdominal cavity of a rubber doll that resembles a 3 kg newborn. We use silicone finger covers and tubular latex balloons (as proximal and distal duodenum and bowel). The cost of materials was less than $50US. Video endoscopic equipment and 3 mm instruments were used. We reproduced all steps of the procedure: dissection of the proximal pouch, finding the distal duodenum below the transverse mesocolon, opening of both blind duodenal ends and performance of a duodenoduodenal anastomosis. We use a validation sheet to evaluate the performance: number of errors and type of injuries, quality of the anastomosis, and time of practice. A video camera was connected with a videoconference equipment through Internet under 1 MB for telementoring. Two pediatric surgery fellows were mentored by three faculties with focus in both the use of the lens and performance of the correct steps to repair a DA. Both of them had previously attended a basic and advanced MIS hands-on programs in our institution and developed skills for advanced suturing and working in small spaces. Mentors and mentees had a human and academic previous relationship. The development checklist sheet was filled after consensus. Results: The procedure was completed without injuries in 75 minutes. Interaction was effective without need to assist them in person. Discussion: Telementoring MIS simulation could assist in the provision of teaching advanced skills worldwide. No competing financial interests exist. Runtime of video: 5 mins This video was presented at 25th IPEG annual meeting, May 24–28 2016, Fukuoka Japan.