Development and Preliminary Validation of a Rabbit Model of Duodenal Atresia for Training in Pediatric Surgical Skills

Abstract

Duodenal atresia is a congenital defect that requires advanced surgical skills. The objective of this study is to present an anatomical defect of duodenal atresia using a rabbit model and evaluate the preliminary experience for the training of surgical skills with pediatric surgeons. Adult white New Zealand male rabbits weighing 3.0 to 4.5 kg were used to create the defect. To simulate the bottom of the dilated blind pouch, the gastric antrum of the rabbit was obliterated using a 2-0 Prolene suture, and the cecal appendix was dissected to simulate the continuation of the duodenum. Participants performed laparoscopic duodenal atresia repair in this animal model using the iPhone trainer. Thirteen pediatric surgeons with experience in laparoscopic duodenal atresia repair assessed this model with a questionnaire on 5-point Likert-type scale. Overall, the simulated model of duodenal atresia obtained a general average score of 4.39. The highest observed average was for its physical realism, whereas the lowest score was in surgical experience. The global opinion of the model obtained a score of 4.40. In addition, all surgeons answered that this rabbit model showed the same complexity as newborns and young children in the repair of this type of defect. The inclusion of new models through rabbits in pediatric surgery programs will allow the development of advanced skills of pediatric residents and surgeons.

Characterization of technical skill progress in a standardized rabbit model for training in laparoscopic duodenal atresia repair

“…This suggests that a minimum number of five laboratory surgeries is definitely needed in the present diamond-shaped anastomosis model, but any further skill development should most probably be monitored under clinical conditions. Our findings are also supported by results from participant feedback forms which are regarded as important tools to gain insights into personal or self-assessment [2,12,13]. The feedback questionnaire used in our study showed that both groups found the task similarly challenging at different stages of the study and the values gradually increased in parallel with the improvement in technical skills (as indicated by the GOALS score).…”

“…Surgery time is one of the most objective and easily accessible indices of performance [6,12,13,25,26], which was found to be similar to those in clinical practice Fig. 4 Average GOALS score (A), depth perception score (B), bimanual dexterity score (C), efficiency score (D), tissue handling score (E) and overall performance score in the beginner and advanced groups for laparoscopic diamond-shaped anastomosis [22].…”

“…The size of the animals used in our model corresponds to the size of premature neonates who are often subjects of this rather challenging laparoscopic duodenal atresia operation. The feasibility of another rabbit model of laparoscopic duodenal atresia repair (gastro-duodenostomy) was also tested elsewhere, but it was only based on a single surgical intervention [ 13 ]. Here, characterization of the model was based on an analysis of individual learning curves during eight operations.…”

“…As for training alternatives, high-fidelity models are required to adequately simulate pediatric surgical conditions. Although many simulation-based training methods have been established [2][3][4] and numerous inanimate solutions have appeared recently [4,5], the superiority of live anesthetized animal models over ex vivo, virtual reality and plastic models has been suggested [6][7][8][9][10][11][12][13]. A key issue here is transferability of laboratory skills to real clinical scenarios.…”

“…Quantitative assessment can focus on multiple factors, such as (a) duration of the intervention, (b) success of the surgery, (c–d) occurrence of a number of intraoperative complications and their management, or (e) the surgeon’s technical skills and bimanual dexterity. (f) Another important aspect is self-evaluation of the participants’ own performance using standardized criteria [ 2 , 12 , 13 ].…”