Bowel Anastomosis Training Simulator: Initial Validity Testing With Video Review Intervention

Surgical simulation advances surgical skill acquisition outside the operating room. This study evaluated the content validity of a novel Bowel Anastomosis Training Simulator (BATS) to perform hand-sewn bowel anastomosis at a single tertiary academic center. BATS is a 3D-printed base and stand holding commercially available three-layer synthetic bowel, which enables pressurized leak testing of the completed anastomosis.

Attending surgeons and surgical residents performed a running single layer side-to-side hand-sewn bowel anastomosis followed by leak testing and a five-point Likert scale questionnaire. Resident participants were assorted into two groups prior to performing the anastomosis: one group reviewed a video of an attending completing the anastomosis, the control group had no video review. Data collected included time to complete anastomosis, leak pressure/location, surveys about simulator validity and the value of video review and leak testing.

Seventeen attending surgeons and twenty general surgery residents participated. Median time/leak pressure for attendings was 20:05 min/11.00 mmHg and 27:52 min (P = 0.0064)/13.00 mmHg for residents. Resident completion time in the video group was 10:59 min faster (P = 0.0288) than the control group. Post graduate year 3-5 residents had significantly shorter times and higher leak pressures than junior residents. Median scores for attending and resident validity questions were 4/5. All participants agreed BATS would increase confidence in resident operating performance.

This study establishes the content validity of BATS for performing an open hand-sewn bowel anastomosis. Presimulation task video review improves trainee performance. Future directions include BATS evaluation in laparoscopic/robotic simulation settings and exploring how tasks translate to operating room performance.