Ann Surg Treat Res.  2022 Jun;102(6):328-334. 10.4174/astr.2022.102.6.328.

The development and clinical efficacy of simulation training of open duct-to-mucosa pancreaticojejunostomy using pancreas and intestine silicone models

• Kang JS
• Sohn HJ
• Choi YJ
• Byun Y
• Lee JM
• Lee M
• Kang YH
• Kim HS
• Han Y
• Kim H
• Kwon W
• Jang JY

• KMID: 2530387
• DOI: http://doi.org/10.4174/astr.2022.102.6.328

Abstract

Purpose
As pancreaticojejunostomy (PJ) is a challenging anastomosis, an education program is needed to train young surgeons to perform PJ. This study evaluated the effects of simulation-based training of open PJ using pancreas and intestine silicone models.
Methods
Five videos pancreatobiliary clinical fellows who did not perform PJ participated in this study. After watching the master video created by a senior pancreatobiliary surgeon, each trainee performed the PJ using silicone models and recorded them 10 times using a video camera. Of these videos, 5 were randomly duplicated due to the validation of the scoring system. The scoring system developed consisted of 20 scores. Three pancreatobiliary professors scored their performance by watching videos.
Results
The mean procedure time of the 5 trainees was 25.4 minutes (range, 23.5–27.3 minutes) in the first video and 15.8 minutes (range, 13.8–19.1 minutes) in the 10th video. The mean score was 12.6 (range, 5–19) and 18.3 (range, 15–20) in the first and 10th videos, respectively. The scores were similar among the duplicated videos for each supervisor.
Conclusion
This education system would help pancreatobiliary trainees to overcome learning curves efficiently without ethical issues related to animal models or direct practice to human patients.

Keyword

Pancreaticojejunostomy; Physical education and training; Simulation training

Figure

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  Fig. 1 Pancreas and intestine models used in this study. They are made of silicone and the cost of 1 pancreas and 1 intestine is 400 US dollars.

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  Fig. 2 Overall flowchart of study design. Ten original video files were recorded and 5 video files were randomly selected and duplicated. After the rearrangement of total 15 video files, they were sent to each supervisor.

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  Fig. 3 The still-cut images of the master video. (A) Two transpancreatic U-shaped sutures were established. Duct-to-mucosa sutures were performed in the dorsal side (B) and in the ventral side (C). (D) The uncut transpancreatic U-sutures and the interrupted sutures were performed in the ventral and central part of the pancreaticojejunostomy.

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  Fig. 4 The tendency of total procedure times of 5 trainees.

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  Fig. 5 The tendency of a total score of 5 trainees according to each supervisor.

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