Development of a Curriculum for Simulated Training of a Laparoscopic Anastomosis

ABSTRACT Introduction: Simulation programs allow a safe and efficient environment for acquiring surgical skills, and astructured curriculum for simulated bowel anastomosis training provides a valuable educational exercise for second year medical residents. Presently, there is no standardized training curriculum which can be used to teach basic and advanced laparoscopic surgery through the preparation of a gastroenteroanastomose. Objective: To develop a systematized curriculum for training by simulation of a laparoscopic surgical anastomosis. Methods: A longitudinal and quantitative experimental study. The sample consisted of twelve general surgery residents from four hospitals. The training consisted of proceeding ten anastomoses divided equally into five sessions and it took place over a six-week period. Laparoscopy-assisted anastomosis between asynthetic stomach and synthetic bowel was performed in a black box with silk threads. At the end of the training, a Likert scale-based questionnaire was answered by the residents to evaluate the proposed training curriculum. Results: The training participants scored the proposed training curriculum very well. The items that recorded the highest evaluation were the need for the training to be offered at the teaching hospital and for it to be a compulsory element of the work. The lowest scoring items were the tweezers and wires used. A reduction in the operation time was observed, taking it close to that achieved by specialist surgeons. Conclusion: A structured curriculum for the simulation of a laparoscopic gastrojejunal anastomosis should foresee participation in 20 anastomoses, 10 as the main surgeon and 10 as the assistant surgeon. The procedures should be distributed over 5 sessions, with an approximate interval of 1 week and over the course of a 6-week period. Training using synthetic organs and a black box should be mandatory, accessible and accompanied by an experienced surgeon who provides individualized feedback.