Section of Thoracic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, Mich.
Product Design Engineer, Ann Arbor, Mich.
J Thorac Cardiovasc Surg. 2020 Dec;160(6):1598-1607. doi: 10.1016/j.jtcvs.2020.02.099. Epub 2020 Mar 13.
At least partially technically related, a cervical esophagogastric anastomosis has a 12% to 14% leak rate, which is theoretically reducible with simulator practice. Preliminary development and testing of a cervical esophagogastric anastomosis simulator are described.
A portable, low-cost, scale reproduction of the cervical esophagogastric anastomosis operative site was engineered around a 19 × 11 × 6-cm plastic box. Silicone "esophageal" and "gastric tip" castings permitted construction of a stapled side-to-side cervical esophagogastric anastomosis guided by an illustrated curriculum. In a 2-phase pilot study, the simulator and curriculum were evaluated. Phase 1: Seven faculty evaluated fidelity using a 5-point, 24-item survey of (1) physical attributes, (2) realism of materials, (3) realism of experience, (4) value, and (5) relevance, and (6) ability to perform tasks. Overall impression of the simulator was also measured. Phase 2: Eight thoracic surgical trainees similarly evaluated the simulator and the quality of the curriculum. Faculty and trainee ratings were compared using a Rasch model, and inter-rater agreement was estimated.
There were no overall fidelity differences across faculty and resident ratings. Combined observed averages ranged from 4.52 (Realism of Materials) to 5.00 (Relevance). Lifelike feel of esophagus had the lowest ratings (observed average = 4.40). Residents rated interrupted outer layer of anterior closure to be more difficult (observed average = 4.13) than faculty (observed average = 4.86; P = .016, d = 1.99). Global ratings (observed average = 3.33/4.00) indicated participants believed the simulator could be used for cervical esophagogastric anastomosis training now, but could be improved slightly.
Preliminary evidence suggests the novel cervical esophagogastric anastomosis simulator is valuable as a surgical training tool.
至少部分技术相关，颈食管胃吻合术的漏率为 12%至 14%，理论上可以通过模拟器练习降低。本文描述了颈食管胃吻合术模拟器的初步开发和测试。
围绕一个 19×11×6cm 的塑料盒，设计了一种便携式、低成本、按比例缩小的颈食管胃吻合术手术部位的复制品。硅酮“食管”和“胃尖”铸件允许在带有插图课程的引导下构建吻合钉侧侧颈食管胃吻合术。在 2 阶段试点研究中，评估了模拟器和课程。第 1 阶段：7 位教员使用 5 分 24 项的调查评估了逼真度，调查内容包括：（1）物理属性，（2）材料的逼真度，（3）经验的逼真度，（4）价值，（5）相关性以及（6）完成任务的能力。还测量了对模拟器的整体印象。第 2 阶段：8 名胸外科受训者以类似的方式评估了模拟器和课程的质量。使用 RASCH 模型比较教员和学员的评分，并估计评分者之间的一致性。
教员和住院医师的评分没有总体保真度差异。综合观察平均值从 4.52（材料的逼真度）到 5.00（相关性）不等。食管的逼真感觉得分最低（观察平均值为 4.40）。住院医师认为前侧中断外层比教员（观察平均值为 4.86；P=0.016，d=1.99）更难。总体评分（观察平均值为 3.33/4.00）表明参与者认为模拟器现在可以用于颈食管胃吻合术培训，但可以稍作改进。
初步证据表明，新型颈食管胃吻合术模拟器是一种有价值的手术培训工具。
