Background Porcine intestine is the mainstay of small bowel (SB) surgical simulation.1 These tissues of healthy young animals, although excellent for basic skills, cannot provide high fidelity for more complex surgical simulation involving pathological SB. In addition there is potential infection control and ethical/cultural issues. We explored creating a SB phantom would solve these problems.
Methodology SB substitute was created by a double layer processed collagen sausage casing joined by a thin layer of dilute coloured gelatine/ADAMgel (Aqueous Dietary fibre Antifreeze Mix gel) mix. This was filled with fluid spill absorption granules soaked in coloured fluid representing SB content. This was intertwined with and wrapped in a thin film of water rich ADAMgel, and left outside to cure for 48 h.
Results The ADAMgel film dehydrated causing it to toughen and become more adherent to SB. This created an excellent model of SB adhesion. Adhesiolysis performed on the specimen felt realistic. The extent and tensile strength of adhesions could be varied emulating anatomical pathology. The SB analogue could be incised, sutured, resected and anastomosed using same equipment and techniques as with human SB. It was not as robust as healthy pig gut, and thus more like SB encountered with adhesions. The SB model can be made more friable by using a single collagen skin, or more robust by adding tubinette between the two layers. A mesentery can be attached to the SB by folding over a collagen sheet and inserting a film of ADAMgel between the two layers. Both diathermy and harmonic scalpel can be used on all components.
Conclusion It is possible to create a SB phantom for surgical simulation that emulates pathology and variety. The cost is the same as pig intestine per metre (<£1), but can be stored on the shelf and prepared in shorter lengths.
Bijoy M, Thomas M, Dandolu V, Caputo P, Milner R, Hernandez E. Resident education in principles and technique of bowel surgery using an ex-vivo porcine model. Obstet Gynecol Int. 2010;852647
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