Background Endoscopic procedures performed via trans-anal access is a rapidly expanding field of cancer surgery.1 Because of space constraints necessitating a single surgeon, teaching these techniques is mostly simulation based. Animal large bowel can be used for teaching basic Transanal Endoscopic Microsurgery (TEMS) but as is does not accurately portray human anatomy it is not ideal for the more complex TransAnal Minimally Invasive Surgery (TAMIS). Human cadavers are difficult to obtain and very costly and require dedicated structure and equipment. We were asked to build a rectal model including perirectal tissue that was cost effective, haptically realistic, dissectible and suitable for simulation training for TAMIS.
Methodology We constructed a rectal model out of four layers of 5 cm stockinette (appropriately dyed) impregnated with ADAMgel (Aqueous Dietary fibre Antifreeze Mix gel). This was moulded around a plastic drainage pipe, the first two layers representing the mucosal and serosal layer of the large bowel. This was surrounded by ADAMgel meso rectal tissue analogues of appropriate dimension, colour and consistency in anatomical correct positions and then encased in the remaining layers of stockinette representing appropriate fascial layers. Cost were <£5 per specimen. The model was then evaluated by the UK colorectal surgeon with the most experience in teaching TAMIS, and by a group of European surgeons during a TAMIS conference for anatomical and haptic realism and utility as simulation phantom.
Results Feedback were universally positive. The model offered anatomical (dissection and identification of planes) and haptic high-fidelity. The model was easily adaptable to a commercially available training box and allowed the use of an insufflator.
Conclusion This rectal model seems suitable for TAMIS simulation training. Arterial analogues can be inserted in the model for Transanal Haemorrhoidal Dearterialization (THD) teaching as well.
Transanal minimally invasive surgery: a giant leap forward. Atallah S, Albert M, Larach S. Surg Endosc. 2010;24(9):2200–5
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