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Techniques in Coloproctology

, Volume 23, Issue 11, pp 1057–1064 | Cite as

Less is more: creation and validation of a novel, affordable suturing simulator for anorectal surgery

  • S. J. LangenfeldEmail author
  • M. A. Fuglestad
  • K. G. Cologne
  • J. S. Thompson
  • C. Are
  • S. R. Steele
Original Article

Abstract

Background

Duty hour restrictions have increased the role of simulation in surgical education. A simulation that recreates the unique visual, anatomic, and ergonomic challenges of anorectal surgery has yet to be described. The aim of this study was to develop a low-cost, low-fidelity anorectal surgery simulator and provide validity evidence for the model.

Methods

A novel, low-fidelity simulator was constructed, and anorectal surgery workshops were implemented for general surgery interns at a single institution. Face and content validity were assessed with separate questionnaires using a 5-point Likert scale. Participants performed a simulated hemorrhoid excision with longitudinal wound closure, and transverse wound closure. Time-to-task completion and quality of suturing/knot tying were evaluated by a blinded observer to assess construct validity.

Results

Material cost was US $11 per simulator. We recruited 20 first-year surgery residents (novices) and 4 practicing colorectal surgeons (experts), and conducted 3 workshops in 2014–2016. All face and content validity measures achieved a median score greater than 4 (range 4.0–5.0). Time-to-task completion was significantly lower in the expert cohort (hemorrhoid excision with longitudinal wound closure: 195 vs. 477 s and transverse closure: 79 vs. 192 s, p < 0.001 for both). Suturing and knot-tying scores were significantly higher in the expert cohort for both tasks (p < 0.05 for all comparisons).

Conclusions

Our low-fidelity, low-cost anorectal surgery model demonstrated evidence of face, content, and construct validity. We believe that this simulator could be a useful instrument in the education of junior surgical trainees and will allow residents to obtain proficiency in anorectal suturing tasks in conjunction with traditional surgical training.

Keywords

Simulation-based education Anorectal surgery Colorectal surgery Hemorrhoidectomy simulation 

Notes

Author contributions

SJL: concept design, data acquisition, analysis, manuscript drafting, manuscript revision, final approval, and agreement for accountability for all aspects of the work. MAF: analysis, manuscript drafting, manuscript revision, final approval, and agreement for accountability for all aspects of the work. KGC: analysis, manuscript drafting, manuscript revision, final approval, and agreement for accountability for all aspects of the work. JST: analysis, manuscript drafting, manuscript revision, final approval, and agreement for accountability for all aspects of the work. CA: concept design, data acquisition, analysis, manuscript drafting, manuscript revision, final approval, and agreement for accountability for all aspects of the work. SRS: analysis, manuscript drafting, manuscript revision, final approval, and agreement for accountability for all aspects of the work.

Funding

None.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This study was reviewed and approved by the University of Nebraska Medical Center's Institutional Review Board.

Informed consent

Written informed consent was obtained by all participants prior to experimentation.

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of SurgeryUniversity of Nebraska Medical CenterOmahaUSA
  2. 2.Department of Surgery, Keck School of MedicineUniversity of Southern CaliforniaLos AngelesUSA
  3. 3.Department of Colorectal Surgery, Department of SurgeryCleveland ClinicClevelandUSA

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