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Background Surgical management of otosclerosis is technically challenging with studies demonstrating that outcomes are commensurate with surgical experience. Moreover, experts apply less force on the ossicular chain during prosthesis placement than their novice counterparts. Given the predicted decreasing patient pool and the rising cost of human temporal bone specimens it has become more challenging for trainees to receive adequate intraoperative or laboratory‐based experience in this procedure. As such, there is a need for a low‐cost training model for the procedure. Here we describe such a model. Methods A surgical model of the middle ear was designed using computer aided design (CAD) software. The model consists of four components, the superior three dimensional (3D)‐printed component representing the external auditory canal, a 90° torsion spring representing the incus, a 3D‐printed base with a stapedotomy underlying the torsion spring, and a 3D‐printed phone holder to facilitate video‐recording of trials and subsequent calculation of the force applied on the modeled incus. Force applied on the incus is calculated based on Hooke's Law from post‐trial computer‐vision analysis of recorded video following experimental determination of the spring constant of the modeled incus. Results The described model was manufactured with a total cost of $56.50. The spring constant was experimentally determined to be 97.0 mN mm/deg, resulting in an ability to detect force applied to the modeled incus across a range of 1.2 to 5200 mN. Conclusions We have created a low‐cost middle‐ear training model with measurable objective performance outcomes. The range of detectable force exceeds expected values for the task. Level of Evidence: IV., This manuscript describes a low‐cost training model for ossicular chain reconstruction. Using 3D printing, video footage captured using a smart phone and computer vision software, the authors have created a representative training tool with objective outcome measures. These measures can be trended and improved upon by users.

BackgroundIt has been demonstrated that medical students are capable of learning microsurgical techniques. We hypothesize that microsurgical training might give insight into the importance of delicate tissue handling and correct knot tying that could have a positive influence on macrosurgical skills. The primary aim of this study was to evaluate the effect of microsurgical training on macrosurgical suturing skills in novice medical students.Subjects and methodsIn 2018, 46 novice medical students were enrolled and randomized into two groups. The intervention group received both macro- and microsurgical training and the control group received only microsurgical training. Both groups underwent an assessment test that consisted of macrosurgical tasks of three simple interrupted sutures with a square knot and continuous three-stitch long over-and-over sutures. These tests were individually filmed and assessed using the University of Bergen suturing skills assessment tool (UBAT) and the Objective Structured Assessment of Technical Skill global rating scale (OSATS). Questionnaires regarding future career ambitions and attitudes towards plastic surgery were also completed both prior to and following the tests.ResultsThe intervention group needed a longer time to complete the tasks than the control group (12.2 min vs. 9.6 min,p > 0.001), and scored lower on both the UBAT (5.6 vs. 9.0,p > 0.001) and the OSATS (11.1 vs. 13.1,p > 0.001) assessments. The microsurgery course tended to positively influence the students’ attitudes towards a career in plastic surgery (p = 0.002). This study demonstrates poorer macrosurgical skills in the medical students group exposed to microsurgical training. The true effect of microsurgical training warrants further investigation.Level of evidence: Level I, diagnostic study.

OBJECTIVE Stapedotomy is an effective treatment for conductive hearing loss associated with otosclerosis. However, the procedure, especially using the endoscopic technique requires extensive training and experience for optimal results. Due to limited training options in endoscopic stapes surgery, we aim to develop an ovine stapedotomy model and assess its feasibility for surgeons at different training levels. METHODS A fully endoscopic ovine laser-stapedotomy model was developed and described. During repetitive dissections, surgical time required for the different steps to assess the training curve and associated intraoperative complications were recorded in three surgeons of different training level. Additionally, subjective feedback was assessed. RESULTS Successful endoscopic laser-stapedotomy was performed in 25 cases in the ovine model. Assessment of surgical time revealed a stable curve for the experienced surgeon (mean 15:01���min) for the whole training with no intraoperative complications. The fellow showed a gradual reduction of surgical time from 27:21 (first five cases) to 24:10���minutes (last five cases) and the resident a reduction from 42:38 to 21:08���minutes respectively. The assessed learning curve for the trainees revealed a significant association between the operative time and observed intraoperative complications. DISCUSSION In this study, an ex-vivo model for exclusively endoscopic laser-stapedotomy was developed and tested for feasibility. We suggest the ovine model as a cost-effective, easily available, and realistic training model for future otologic surgeons. The surgeons were able to improve their performance with satisfactory results despite the small number of cases.

OBJECTIVES: A thorough understanding of mitral and aortic valve motion dynamics is essential in mastering the skills necessary for performing successful valve intervention (open or transcatheter repair or replacement). We describe a reproducible and versatile beatingheart mitral and aortic valve assessment and valve intervention training model in human cadavers.METHODS: The model is constructed by bilateral ligation of the pulmonary veins, ligation of the supra-aortic arteries, creating a shunt between the descending thoracic aorta and the left atrial appendage with a vascular prosthesis, anastomizing a vascular prosthesis to the apex and positioning an intra-aortic balloon pump (IABP) in the vascular prosthesis, cross-clamping the descending thoracic aorta, and finally placing a fluid line in the shunt prosthesis. The left ventricle is filled with saline to the desired pressure through the fluid line, and the IABP is switched on and set to a desired frequency (usually 60-80 bpm). Prerepair valve dynamic motion can be studied under direct endoscopic visualization. After assessment, the IABP is switched off, and valve intervention training can be performed using standard techniques.RESULTS: This high-fidelity simulation model has known limitations, but provides a realistic environment with an actual beating (human) heart, which is of incremental value. The model provides a unique opportunity to fill a beating heart with saline and to study prerepair mitral and aortic valve dynamic motion under direct endoscopic visualization.CONCLUSIONS: The entire set-up provides a versatile beating-heart mitral and aortic valve assessment model, which may have important implications for future valve intervention training.

Objectives/Interrogation: Microsurgery is widely used in experimental research models and clinical surgery. However, microsurgical applications require precise technical skills and continuous training. Here, we proposed a new, low cost, practical microsurgery training model, which can be easily[for full text, please go to the a.m. URL], 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

Background Technical advancements in spine surgery have made possible the treatment of increasingly complex pathologies with less morbidity. Time constraints in surgeons' training have made it necessary to develop new training models for spine pathology. Objective To describe the application of a novel compound, Stratathane resin ST-504 derived polymer (SRSDP), that can be injected at different spinal target locations to mimic spinal epidural, subdural extra-axial, and intra-axial pathologies for the use in advanced surgical training. Material and Methods Fresh-frozen thoracolumbar and cervical spine segments of human and sheep cadavers were used to study the model. SRSDP is initially liquid after mixing, allowing it to be injected into target areas where it expands and solidifies, mimicking the entire spectrum of spinal pathologies. Results Different polymer concentrations have been codified to vary adhesiveness, texture, spread capability, deformability, and radiologic visibility. Polymer injection was performed under fluoroscopic guidance through pathology-specific injection sites that avoided compromising the surgical approach for subsequent excision of the artificial lesion. Inflation of a balloon catheter of the desired size was used to displace stiff cadaveric neurovascular structures to mimic pathology-related mass effect. Conclusion The traditional cadaveric training models principally only allow surgeons to practice the surgical approach. The complex spine pathology simulator is a novel educational tool that in a user-friendly, low-cost fashion allows trainees to practice advanced technical skills in the removal of complex spine pathology, potentially shortening some of the aspects of the learning curve of operative skills that may otherwise take many years to acquire. © Georg Thieme Verlag KGStuttgart New York.

Purpose: The purpose of this study was to develop a porcine training model for laparoscopic choledochojejunostomy (CJ) that can act as a bridge between simulation models and actual surgery for novice surgeons. The feasibility of this model was evaluated. Methods: Laparoscopic CJ using intracorporeal sutures was performed on ten animals by a surgical fellow with no experience in human laparoscopic CJ. A single layer of running sutures was placed in the posterior and anterior layers. Jejunojejunostomy was performed using a linear stapler, and the jejunal opening was closed using absorbable unidirectional sutures (V-Loc 180). Results: The average operation time was 131.3 ± 36.4 minutes, and the CJ time was 57.5 ± 18.4 minutes. Both the operation time and CJ time showed a steady decrease with an increasing number of cases. The average diameter of the CBD was 6.4 ± 0.8 mm. Of a total of ten animals, eight were sacrificed after the procedure. In two animals, a survival model was evaluated. Both pigs recovered completely and survived for two weeks, after which both animals were sacrificed. None of the animals exhibited any signs of bile leakage or anastomosis site stricture. Conclusion: The porcine training model introduced in this paper is an adequate model for practicing laparoscopic CJ. Human tissue simulation is excellent.

Objective To evaluate the efficacy of our simply designed trainer for junior urologists to acquire the initial skills for percutaneous renal access (PRA). Subjects and methods Three sponge sheets (60 × 50 × 10 cm) were arranged horizontally over each other. A rectangular groove was made in the middle sheet to accommodate an inflated balloon of a Foley catheter, radio-opaque metal balls, metal rings, or a plastic tube that were sequentially placed for the four training tasks. In each session, 18 trainees were asked to pass a fluoroscopically guided puncture needle from a surface point to the placed object in middle sheet. Clinical impact of training was evaluated by an experience survey on a 5-piont Likert scale (for model usefulness, tactile and fluoroscopic-guidance feedback) and success rate in further mentored practice. Results There was a gradual increase in tasks’ and sessions’ scores over the training sessions. According to the experience survey after first clinical practice, the mean (SD) score for overall model usefulness by trainees was 3.8 (0.9) with high fluoroscopic guidance reality [3.6 (1.1)] but poor tactile realism [2.3 (0.9)]. On mentored PRA, the success rate for trainees was 78.3%. Conclusion Our early evaluation showed our novel, cost-effective and reproducible sponge trainer could be an effective training model for PRA with a beneficial impact on subsequent clinical practice.

OBJECTIVES: Training models are essential in mastering the skills required for off-pump coronary artery bypass grafting (OPCAB). We describe a new, high-fidelity, effective and reproducible beating-heart OPCAB training model in human cadavers.METHODS: Human cadavers were embalmed according to the 'Thiel method' which allows their long-term and repeated use. The training model was constructed by bilateral ligation of the pulmonary veins, cross-clamping of the aorta, positioning of an intra-aortic balloon pump (IABP) in the left ventricle (LV) through the apex (tightened with pledget-reinforced purse strings) and finally placing of a fluid line in the LV through the left atrial appendage (tightened with a pledget-reinforced purse string). The LV was filled with saline to the desired pressure through the fluid line and the IABP was switched on and set to a desired frequency [usually 60-80 beats per minute (bpm)].RESULTS: A high-fidelity simulation has known limitations, but a more complex, realistic training environment with an actual beating (human) heart strengthens the entire training exercise and is of incremental value. All types of coronary artery anastomosis can be trained with this model. Training should be performed under the supervision of an experienced OPCAB surgeon and training progress is best evaluated with serial Objective Structured Assessment of Technical Skills (OSATS). A score of at least 48 points on the final OSATS ('good' on all components) is recommended before trainees can start their training on patients.CONCLUSIONS: The entire set-up provides a versatile training model to help develop and improve the skills required to safely perform beating heart OPCAB anastomoses.

Purpose We introduce a training porcine model for laparoscopic common bile duct (CBD) repair with T-tube insertion. The model could be the feasible training tool for a surgeon learning hepatobiliary surgery. Methods Totally laparoscopic CBD repair with T-tube insertion was performed on 9 pigs by 9 trainees naive in hepatobiliary surgery. Similar to the situation of iatrogenic injury, CBD was transected by laparoscopic scissors at the middle part about 1 cm in length, and the transected CBD was repaired through end-to-end anastomosis with T-tube insertion. A secureness of anastomosis was confirmed by saline leakage test and all animals were sacrificed after the surgery. Results All novice surgeons completed operations successfully without complications. Total mean operative time was 85 ± 1.7 minutes and the mean time spent performing the CBD repair with T-tube insertion was 71 ± 3 minutes. There was no bile leakage after primary anastomosis in all animals. Conclusion This porcine training model for laparoscopic CBD repair with T-tube insertion could be a feasible and effective training tool for surgeons with little experience in laparoscopic hepatobiliary surgery.

Introduction: Changes to surgical working hours have resulted in shorter training times and fewer learning opportunities. Tools that develop surgicalskills ex-vivo are of particular interest in this era. Laparoscopic skills are regarded as essential by many for modern paediatric surgery practice. Several generic skills models have been reported and validated. However, there is limited evidence regarding the role of procedure specific models. Here, a laparoscopic paediatric hernia repair model is trialled with surgical trainees and their competence compared with consultant colleagues. Patients and Methods: An ex-vivo paediatric inguinal hernia repair model was devised. Surgical trainees from 5 specialist centres were recruited and performed multiple standardised repairs.Results: 23 trainees performed 192 repairs. Experts performed 10 repairsfor comparison. Trainees were timed performing the repair and their accuracy measured. With repeated attempts trainee’s timings and accuracy improved until by the 10th repair they were no different from benchmark consultant scores.Conclusion: A simple, procedure specifi c ex-vivo training model has beenevaluated for laparoscopic hernia training in paediatric surgery. The results suggest improvements in competence with repetition. Trainee and benchmark consultant scores are no different by the 10th trainee attempt. We conclude that this model may have a valuable role in the training and assessment of future paediatric surgeons.Key words: Ex-vivo, hernia repair, laparoscopic, paediatric, training model

Comert, Ayhan/0000-0002-9309-838X WOS: 000262838400061 PubMed: 19165035 A cadaver model was used for microvascular training as nonviable biologic model. Twenty-four fixed and 2 fresh adult cadavers were used for microvascular training. The radial artery, ulnar artery, and cephalic vein of the forearm were preferred. Respectively, end-to-end, end-to-side, and end-on-side microanastomosis techniques were performed. A cadaver model has several advantages over other training models. There are numberless vessels to perform different techniques for microvascular anastomoses. Several students can simultaneously work on the same cadaver at the same time. In addition, there is the opportunity of working on vessels of different sizes and diameters. The same conditions on the cadaver can be created before operation, and effective presurgical microvascular practice can be performed. A free-flap dissection can be easily performed to get experience before clinical operations. Furthermore, it may be combined with live animal models.

Training models are becoming increasingly important for gaining surgical skills. We present an easy to prepare and cheap model using cadaver sheep spine appropriate to learn and practice various discectomy procedures. © 2005 Elsevier Ltd. All rights reserved.

OBJECTIVE: We developed a novel ex vivo training model for advanced laparoscopic suturing techniques necessary in laparoscopic radical prostatectomy (LRP). METHODS: An inanimate model was developed to approximate real-life conditions in laparoscopic urethrovesical anastomosis. A segment of porcine ovarian tube inserted through a hard piece of cardboard (urethral stump) in a small open box and a part of pig stomach with a 2-cm hole (bladder neck) were placed in a specially designed setup in a traditional pelvic trainer, while the trocars were arranged in the usual five-port style during an LRP. The trainees practised suturing the “bladder neck” to the “urethral stump” with intermittent or continuous sutures according to their preferences. RESULTS: The setup successfully mimicked the spatial relationships of the organs to be anastomosed during live surgery. The directions of the trocars and the angles of the instrumentations in the training model also imitated those during LRP. After practising on our models, the surgeons spent significantly less time (65 ± 24 min vs. 36 ± 12 min, p = 0.035) performing actual urethrovesical anastomosis. CONCLUSION: This inanimate laparoscopic suturing training model for urethrovesical anastomosis is a novel, effective, convenient and economic training tool, especially for beginners of LRP. [Asian J Surg 2010;33(4):188–92]