A Novel Pelvic Hand-Sewn Bowel Anastomosis Simulator for Surgical Training

Hand-sewn bowel anastomosis (HSBA) is an important skill in general surgery. Due to technological advances such as surgical staplers for bowel, HSBA has become less common thus reducing general surgery residents' exposure to the technique. Difficult anatomical locations such as the pelvis face an even lower clinical exposure, though proficiency is crucial as consequences can include significant morbidity and mortality. Opportunities to develop this skill has been delegated primarily to surgical simulators. Given that cadaveric and porcine training is cost prohibitive and not readily available, the aim of this paper is to present a novel, reusable and cost-efficient simulator for HSBA in the pelvis. The simulator was built using advanced 3D printing methods and silicone-based materials to mimic a real pelvic cavity with emphasis on creating hyper realistic multi layered bowel. This simulator was reviewed by eight experts who performed an HSBA in the pelvic cavity followed by completing a Likert-based scale questionnaire resulting in an overall 92% score, endorsing it as a potential tool for general surgery training. In addition, the simulator is reproducible, provides tactical and haptic feedback to the user making it the first of its kind to combine HSBA in a difficult anatomical region such as the pelvis.Clinical Relevance-This novel pelvis HSBA simulator has the potential to make significant contributions to general surgery residency training to bridge the gap between textbooks and the operating room in a reproducible and cost-effective fashion.