V8-03: Step-by-step technique for robotic intracorporeal bowel anastomosis and development of a simulation training model

Video

Introductions and Objectives
Our group has previously reported on the development and validation of an inanimate robotic skills simulator. There is an increased utility of robotic cystectomy in the treatment of bladder cancer. The performance of a completely intracorporeal urinary diversion requires an effective technique for an intracorporeal bowel anastomosis. We present a surgical approach that has deconstructed the procedure to 4 essential steps. Our goal was to create a novel training model for the intracorporeal bowel anastomosis in robotic surgery (BARS).

Methods
The BARS technique consists of the following steps: division of the bowel with a stapler (1), incision and opening of the bowel limbs at the antimesenterial angle (2), insertion of the stapler into the two bowel limbs for the side-to-side anastomosis (3), transverse closure of the anastomosis with the stapler (4). For the simulation surgeons with varying levels of experience were instructed about BARS in a short educational video. The simulation setup included an abdominal trainer with porcine bowel as well as a bedside surgeon who operated the stapling device. All participants performed the required steps for the intracorporeal bowel anastomosis under standardized conditions. Face and content validity were derived from participants’ rating of the tasks on a 5-point Likert scale.

Results
A total of 14 participants completed all four tasks of the BARS simulation. 2 experts and 10 trainees in robotic surgery completed the online-based survey that we shared with all participants for the evaluation of the BARS exercise. 67% of participants agreed that the technical skills required to complete the training model reflected technical skills required to perform actual robotic intracorporeal reconstruction. 91% of participants found the model to be appropriate in difficulty. 91% of participants agreed that a robotic surgeon skilled in urinary diversion should be able to perform the tasks presented. 88 % of participants agreed that the model would be useful for the evaluation of robotic technical skills proficiency and 91% thought it to be useful for training robotic surgical skills.

Conclusions
We were able to demonstrate that the BARS simulator is a reproducible and realistic simulation which allows for an objective skills assessment. This can have implications for the training of surgeons engaged in robotic intracorporeal urinary diversions.

Funding: none