Novel Low-Cost Low-Fidelity Abdominal Wall Simulation Is Effective for Surgical Education

Abstract

Introduction: Surgical training increasingly employs simulation to facilitate resident education. However, simulations are often costly or use animal tissues, with attendant challenges in their financial and logistical feasibility. We present a foam abdominal wall model for abdominal access and ostomy creation.

Methods: Layers of craft foams and fabrics are used to accurately simulate the layers of the abdominal wall, both on and off midline. Sixteen general surgery junior residents were proctored by a colorectal surgeon to complete each simulation. Residents completed pretask and post-task 5-point Likert-scale regarding comfort with technical skills. Improvement in these metrics was the primary outcome of interest. Wilcoxon matched pairs signed rank test was performed, preselected alpha was set at 0.05.

Results: Residents reported that their confidence in all aspects of stoma creation improved following completion of the lab. On prelab versus postlab survey, residents significantly increased in overall technical comfort by 2 points (P < 0.001), comfort in siting the stoma by 1 point (P < 0.001), creating the trephine by 2 points (P < 0.001), and securing the stoma by 1 point (P < 0.001). On pretest versus post-test survey residents significantly improved their technical comfort with Veress needle by 2 points (P < 0.001), optical trocar by 1 point (P < 0.001), and Hasson by 1.5 points (P < 0.001).

Conclusions: This model is easy to make and effective in increasing resident-reported comfort with ostomy formation and abdominal access. This offers an opportunity for residents to practice critical procedures in general surgery at low-cost and with no associated patient risk.

Keywords: Abdominal access; Low-fidelity simulation; Ostomy formation; Simulation; Simulation model; Surgical education; Surgical residents.