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Rajesh Panwar*, Hemanga Bhattacharjee, Seenu Vuthaluru, Ambuj Roy, Peush Sahni
All India Institute of Medical Sciences, New Delhi, Delhi, India

Background: Simulation based training allows the trainees to acquire surgical skills in a stress free environment and also ensures patient safety. We have developed a two-day training module for teaching hepaticojejunostomy to the surgical residents on an animal tissue based simulation model using porcine liver and small bowel (Figure 1). We conducted this study to evaluate the effectiveness of this module.

Methods: We enrolled surgical trainees from Gastrointestinal surgery and General Surgery departments to participate in the two-day course. Each participant performed and assisted five hepaticojejunostomies on the simulation model. Participants were shown a pre-recorded intra-operative video of a hepaticojejunostomy as well as a pre-recorded video of a hepaticojejunostomy performed on the simulation model. Participants were also mentored throughout the course. The participants were assessed at the start and at the end of the course in terms of time to complete the anastomosis in minutes, anastomotic leak test result and a practical knowledge-based test. A feedback was also collected from the participants after the completion of the course.

Results: Eighteen surgical trainees participated in the course from April 2022 to October 2022. The mean time taken to complete the anastomosis decreased significantly from 43.1 +/- 10.6 minutes at the start of the course to 23.6 +/- 5.0 minutes at the end of the course (p<0.001). The rate of positive anastomotic leak test also decreased from 55% to 11% (p=0.008). The scores in the practical knowledge-based test improved from 4.1 +/- 1.7 to 6.4 +/- 0.8 (p<0.001). All the participants provided positive feedback regarding the course (Table I).

Conclusion: The hepaticojejunostomy training module significantly improved the surgical skills and the practical knowledge of the trainees. It also met the expectations of the participants as suggested by the immensely positive feedback. Further studies are required to assess whether this also transforms into improvement in the operative room performance.

Figure 1. The animal tissue model for hepaticojejunostomy

Table I: Participant's feedback regarding the hepaticojejunostomy training module

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