Face, content, and construct validities of inanimate intestinal anastomoses simulation

Surgical simulation modules for "open" surgery are limited and not well studied or validated. Available simulation modules use either synthetic material, which is convenient but may not mimic what is observed or felt in the operating room, or live animal laboratories, which can simulate human tissue but are costly and not readily available. An intestinal anastomosis simulation was devised with thawed porcine intestine. In this study, the face, content, and construct validities of this simulation module were analyzed for both hand-sewn and stapled anastomoses.

Participants were timed on performing a 2-layered, hand-sewn anastomosis, as well as a side-to-side, functional, end-to-end, stapled anastomosis on thawed porcine small bowel. Anastomoses were examined for adequacy and measured for luminal narrowing and bursting pressure by intraluminal saline infusion. Questionnaires were answered regarding impressions with the simulation modules. Face, content, and construct validities were evaluated by comparing junior residents to senior residents and faculty. Data collected were analyzed with 2-sample t-tests.

Both hand-sewn and stapled anastomoses showed strong face and content validity. Overall impressions of these inanimate simulation modules were a positive experience as reflected by the comments of participants. For hand-sewn anastomoses, a significant difference was found between junior and senior group times (50.0 +/- 17.2 vs 33.0 +/- 9.7 minutes, p = 0.013) as well as PGY-1 and faculty times (64.0 +/- 7.2 vs 28.0 +/- 3.8 minutes, p = 0.001). Bursting pressures varied between both groups and were not significant. For stapled anastomoses, no difference was noted between the various groups in completion time or bursting pressure.

Hand-sewn and stapled inanimate intestinal anastomoses are a valid simulation of intraoperative experience based on the face and content validities. Although stapled anastomosis does not have good construct validity, the more challenging hand-sewn anastomosis does differentiate between various skill levels.