![]() ![]() ![]() At the national level, the American Society of Transplant Surgeons offers annual deceased human body-based simulation workshops on laparoscopic donor nephrectomy and donation after cardiac death, which is intended for transplant surgery fellows. However, the availability of simulation-based tools to complement the quantitative and qualitative educational experience of residents during their transplant surgery rotation has been limited. ![]() In the general surgery setting, simulation has been incorporated into the residency curriculum as a validated tool to assess technical skills acquisition and intraoperative performance improvement in minimally invasive surgeries. Ī simulation is an educational tool that is well established in non-medical fields such as the military and aviation. The time to perform these anastomoses, the warm ischemic time, has in fact been shown to have a direct relationship with the development of important negative post-kidney transplant outcomes such as delayed graft function, graft loss, and mortality. Attending transplant surgeons might therefore be reluctant to delegate critical portions of the case to an inexperienced resident given the time-sensitive venous and arterial anastomoses during a kidney transplant. Kidney transplants often happen on an emergent basis during off-hours, and complications are highly scrutinized with punitive actions taken against transplant centers with below-than-expected outcomes. Moreover, operative volume alone does not fully capture whether residents acquire meaningful surgical technical proficiency and procedural understanding. Residents also compete with transplant surgery fellows for operative volume in certain transplant centers. ĭuring a transplant surgery rotation, the high service demand of care for medically complex patients often negatively impacts operative room access for residents. However, residents on average participate in only 5.9 ± 7 kidney transplants during their entire training, with 30% lacking the confidence to perform vascular anastomosis by the time they graduate. Out of all transplant procedures, kidney transplant usually provides the best opportunity for residents to significantly put into practice vascular anastomosis, a skillset they are rarely exposed to on other surgical rotations. In the current 80-hour workweek restriction environment set by the Accreditation Council for Graduate Medical Education, the traditional Halstedian apprenticeship model of graded responsibility is likely insufficient to consistently meet the quantitative and qualitative education demands of general surgery residents while simultaneously preserving patient safety, especially during transplant surgery rotations. Our novel low-cost bench-top kidney transplant surgery simulator focusing on vascular anastomoses received positive educational feedback from residents. ![]() Residents thought that the simulator was less difficult than real-life procedure, had acceptable fidelity levels, and they highly rated its educational utility. The iliac fossa and allograft cost $20.20 and each practice run cost $7.20. Residents performed and assisted in vascular anastomoses on the simulator. A modified kidney-shaped stress ball with 1.27 x 4, 0.64 x 4, and 0.64 x 15 cm Penrose drains replicated a kidney allograft with its vein, artery, and ureter, respectively. Hooks attached to the box’s sidewall held under tension 1.27 and 0.64 cm diameter Penrose drains to replicate the external iliac vein and artery. Eighteen residents with real-life kidney transplant experience trialed the simulator and scored its fidelity and educational utility on a 0-100 visual analog scale (VAS) survey.Ī 35.9 x 19.4 x 12.4 cm plastic box mimicked the iliac fossa. We searched for inexpensive materials to design an iliac fossa and kidney allograft. In light of this, we created a low-cost bench-top kidney transplant surgery simulator to help residents practice vascular anastomoses. Resident inexperience during time-sensitive vascular anastomoses of a kidney transplant can negatively impact outcomes. ![]()
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