Welcome to the AHS 2020 ePoster Session. Please scroll down to view all of the submitted posters or press Control-F to search. To view the poster and its abstract, click on the poster image. Many posters also have a brief audio introduction which can be played by going to the bottom of the poster screen.
P020: DEVELOPMENT OF A LAPAROTOMY TRAINER: THE CLOS-IT SYSTEM
Victor Moas, MD1; Christopher Dyke, MD1; Brenton Franklin, MD1; Eric M Ritter, MD1; Peter Liacouras, PhD1; Steven Kurapaty2; Spencer Vandecar3; Jason Souza, MD1; William Sweeney, MD1; 1Walter Reed National Military Medical Center; 2The George Washington University School of Medicine; 3Uniformed Services University of the Health Sciences School of Medicine
Background: Surgically gaining access to the peritoneal cavity (laparotomy) is a fundamental general surgery skill that consists of a midline incision of variable length through the abdominal wall. Creation and subsequent closure of the laparotomy can be taught with animal models, but most often occurs during elective or emergent abdominal surgery on patients. We developed and tested a realistic, low-cost, synthetic abdominal wall to be used in a simulation curriculum for laparotomy creation, as well as proper fascial and skin closure: the CLOS-IT System (Closure of the Laparotomy in Open Surgery – Instructional Trainer).
Methods: The CLOS-IT uses our group’s recently invented synthetic fascia. This construct was validated for biomechanical similarity to porcine fascia as well as for subjective realism by experienced surgeons in a prior study. The fascia was incorporated into a composite of several pigmented silicone layers simulating skin, subcutaneous adipose tissue, and abdominal rectus muscles. The rectus muscles were molded to produce a simulated linea alba along the model’s midline. Prototypes were revised and improved over several iterations until a suitably realistic model was achieved.
The CLOS-IT System was then tested for realism and appropriateness for simulation training use by 10 experienced surgeons. Each surgeon performed a 10cm laparotomy on the model, followed by closure of the fascia and skin. Fascial closure was performed with either 1 or 2-0 polydioxanone suture, with each surgeon free to close according to their preferred technique.
Results: 10/10 surgeons described the model as an acceptable model for simulating midline laparotomy, and 9/10 described the model as acceptable for midline laparotomy simulation training.
Material cost for each additional synthetic abdominal wall was approximately $18 (several different silicone formulations, powermesh fabric, silicone adhesive) with a one-time cost of $50 for mold creation. Total manufacturing time was about 21 hours and included 3 phases: (1.) Creation of fascia: 20 minutes of synthetic time followed by 16 hours of cure time, (2.) Creation of skin, adipose tissue, and musculature, with incorporation of fascia into musculature: 30 minutes synthetic time followed by a cure time of 4 hours for muscle and skin, and 2 hours for subcutaneous adipose tissue (3) final assembly of components with silicone glue. Shelf life for the final product appears to be at least several months.
Conclusions: The CLOS-IT System is a realistic, low-cost instructional model designed for teaching surgical trainees laparotomy creation and closure. We are creating and implementing a curriculum using the CLOS-IT System for surgery-matched medical students and surgical interns. Future directions include the development of a ventral hernia repair CLOS-IT System curriculum.
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