Development and Validation of a Low-fidelity Simulator to Suture a Laparotomy in Rabbits
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Owner/Developer: Department of Agricultural and Animal Production, Autonomous Metropolitan University of Mexico
01 January 2015
There is a growing need for the development of alternatives
to reduce, replace and refine the use of animals
for surgical training in contemporary veterinary
education at the undergraduate level. In the present
study, a simulator to suture a midline laparotomy in
the rabbit was designed, that could be constructed
from widely-available and low-cost materials. The
simulator was used to develop surgical skills in students
at the undergraduate level of veterinary medicine.
Thirty-five, third-year veterinary students,
with no previous surgical experience, were divided
into two groups: a control group that did not use the
simulator (n = 19), and an experimental group that
used the simulator three times to practise the suturing
of a laparotomy (n = 16). Later, both groups performed
a midline laparotomy in an anaesthetised
rabbit, and the rate of closure of each anatomical
plane (peritoneum, additional reinforcement, and
skin) was measured.
veterinary medicine and zootechnics students
Models of animals (e.g. mannequins, simulators, cadavers)
Partial coverage (e.g. a module)
Rabbits (Oryctolagus cuniculus)
|Course level on animal species:||
|Details on the topic or technology covered:||
Thirty-five students in the third year of a veterinary medicine and zootechnics course at the Universidad Autónoma Metropolitana, Unidad Xochimilco, with no previous experience in surgery, received a 120-minute theory session, supported with slides, on the midline laparotomy technique and suture in rabbits.9 This was part of the Surgical-Veterinary Therapeutic Bases module. Later, the students were divided into two groups: the experimental group (n = 16), which was organised in four surgical teams of four participants each, and the control group (n = 19), which was divided in four groups of four participants and one three-participant group. Each student was assigned his/her rotation within the group, in such a way that they all covered all the roles once (surgeon, first assistant, scrub nurse, and anaesthesiologist). Each surgeon/first assistant team (according to the assigned rotation) of the experimental group used the laparotomy simulator two days prior to the practice on the live animals. They were asked to repeat three times the following procedure: put the surgical drapes in place (Figure 2b); perform a 7cm incision, including all the layers of the simulator; suture, with continuous stitches, the first silicone layer (peritoneum), which was reinforced with inverted ‘U’ stitches; and suture, with Sarnoff stitches, the second silicone layer (skin). The first assistant was only allowed to help the surgeon in handling the surgical instruments that were used. The closure of planes was performed by using nylon 2-0 suture (Figure 3)
On the other hand, the experimental group demonstrated better suture skills for the laparotomy in rabbits after performing three repetitions of the procedure in the simulator. These findings agree with those reported by Aggarwal,12 who found in his study that laparoscopic surgeons required two repetitions of a particular procedure in a simulator, in order to learn it. The simulator required them to hold the tissue, lift it up, place a clip, and then cut; for trainees, seven repetitions were required to learn to perform the same procedure. However, we have to take into consideration that this particular procedure would have a longer learning curve than performing a suture
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