Impact of a low-cost lamb anus Hirschsprung pull-through surgery model: results from a structured national workshop

A nationwide simulated Hirschsprung's Soave pull-through surgery (HPTS) workshop using a lamb model was set up to train pediatric surgeons. Operative confidence, skills acquisition and clinical application were evaluated.

The model (< 5 USD) comprised fresh lamb anorectum with terminal perianal muscle and skin preserved and a 20-cm rectum, inserted and fixed onto a mini basket, which allowed dissection using monopolar diathermy. Each trainee performed the five-step Soave procedure twice under supervision. Operative confidence for each step was measured pre- and post-workshop using a 10-point Likert scale, with model realism and utility similarly rated. A 3-6-month follow-up survey assessed clinical translation.

Seventeen participants and 14 trainers from nine centres facilitated completion of 34 simulated procedures. Median overall confidence improved from 2.5 to 7.0 (P < 0.0005), with the greatest gains obtained in submucosal dissection (2.0 to 8.0), cuff management (2.0 to 8.0) and anastomosis (3.0 to 8.0) (all P < 0.001). Model realism and training utility were rated 9/10 and 9/10, respectively, by 25 respondents (93% response rate). Follow-up survey (12/17; 71%) showed 100% agreement that the workshop improved ability to assist or perform HPTS.

This structured simulation-based HPTS workshop, using a validated low-cost model, significantly improved procedural confidence which translated into behavioural change in clinical practice. The model offers high fidelity, scalability and ethical training.