Date Published: September 16, 2019
Publisher: Sociedade Brasileira para o Desenvolvimento da Pesquisa em Cirurgia
Author(s): Deivid Ramos dos Santos, Faustino Chaves Calvo, Daniel Haber Feijó, Nayara Pontes de Araújo, Renan Kleber Costa Teixeira, Edson Yuzur Yasojima.
To develop a new low-cost, easy-to-make and available training model using chickens’ intestine for infant intestinal anastomosis.
Segments of chicken intestine were used to create an intestinal anastomosis simulator. We tried to perform an end-to-end, end-to-side and side-to-side anastomosis. Handsewn sutured anastomosis were performed in single layered with interrupted prolene 5-0 suture. The parameters analyzed were cost, intestine’s diameter and length, anastomosis patency and flow-through and leakage amount.
In all cases it was possible to make the anastomosis in double layered without difficulties, different from the usual ones. There was a positive patency at all anastomoses after the end of the procedure, with no need for reinterventions.
The new training model using chickens’ intestine for infant intestinal anastomosis is low-cost, easy-to-make and easy available.
Intestinal anastomosis becomes necessary when the segment on the gastrointestinal tract is resected for benign or malignant conditions and gastrointestinal continuity needs to be restored1. Failure of an anastomosis with leakage of intestinal contents is one of the most significant surgical complications1,2. Reported failure rates range from 1 to 24%, depending of the surgeon’s experience, what type of anastomosis was performed and whether the operation was an elective or an emergency procedure1,3,4.
The research followed the rules of the Brazilian Law for Animal Care (Law: 11.794/08) that is based on NIH guidelines, and followed the rules of Council for International Organization of Medical Sciences ethical code for animal experimentation and the European Convention for the Protection of Vertebrate Animals Used for Experimental and Other Scientific Purposes.
The diameter and length of the chicken intestine used ranged from 0.5 to 3 cm (mean: 2.08 ±0.77 cm) and 100 to 120 cm (mean: 108.44 ±7.59 cm), respectively. On average, 12 simulators were produced with one bowel. The average time for making a simulator was 9.22 ±1.45 minutes. All models showed no signs of deterioration within 30 days of observation when stored under refrigeration. The cost of each simulator was approximately U$ 3.80.
Pediatric surgeons must have a versatile technical skill set, to address several surgical sites (gastrointestinal, thoracic, urologic surgery, and others)7,10. To develop these abilities, it is necessary a sustained practice and a continuous education input. The old model of surgical training based on the maximal “see one, do one, teach one” has been increasingly questioned10,14. Progressively, there is a change to a constant, and initially supervised, training model. This change stems from the high rates of morbidity and mortality and an increase in the length of hospital stay that occurred due to the initial practice directly in humans7,8,11.
The new training model using chickens’ intestine for infant intestinal anastomosis is low-cost, easy-to-make and easily available. This model could be used for practice end-to-end, end-to-side and side-to-side anastomosis, improving intestinal anastomosis skills on most metrics by engaging in simulation-based training.