Surgical Simulation of Posterior Sagittal Anorectoplasty for Rectovestibular Fistula: Low-Cost High-Fidelity Animal-Tissue Model.
Document Type
Article
Publication Date
10-2023
Identifier
DOI: 10.1016/j.jpedsurg.2023.02.055
Abstract
PURPOSE: To provide a high-fidelity, animal tissue-based model for the advanced surgical simulation of a Posterior Sagittal Anorectoplasty (PSARP) for rectovestibular fistula in anorectal malformation (ARM).
MATERIALS AND METHODS: A chicken cadaver was used to assess the feasibility of simulating a PSARP for rectovestibular fistula in ARM. No modification was required to implement the surgical simulation.
RESULTS: A detailed description of the high-fidelity surgical simulation model is provided. The PSARP can be simulated while providing realistic anatomy (e.g. common wall between rectovestibular fistula and vagina), adequate rectal size, location and placement of the rectovestibular fistula, and proximity to the vagina. Haptic conditions of the tissue resemble human tissue and operative conditions as well.
DISCUSSION: Concerning the decreased exposure of index cases of pediatric surgical trainees and pediatric surgeons in practice, simulation-based training can provide means to acquire or maintain the necessary skills to perform complex surgical procedures [1-5] Surgical simulation models for ARM are limited. Few low-cost trainers are available with predominant artificial and mostly unrealistic tissue [6-8] Animal models have the advantage of realistic multilayer tissue haptic feedback [6].
CONCLUSION: We provide a low-cost, high-fidelity model for correcting a rectovestibular fistula in a child with ARM, a complex operative procedure with low incidence but high-stake outcomes. The described tissue model utilizing the chicken cloaca anatomy provides a high-fidelity model for operative correction of rectovestibular ARM. For simulation purposes in the treatment of ARM, this model appears to be promising in terms of providing realistic pathology and haptic feedback in pediatric dimensions.
LEVEL OF EVIDENCE: V.
Journal Title
Journal of pediatric surgery
Volume
58
Issue
10
First Page
1916
Last Page
1920
MeSH Keywords
Female; Child; Humans; Infant; Retrospective Studies; Rectum; Rectal Fistula; Plastic Surgery Procedures; Anorectal Malformations; Anal Canal; Rectovaginal Fistula
Keywords
Animal-tissue; Anorectal malformation; Model; Posterior sagittal anorectoplasty; Simulation
Recommended Citation
Jhala T, Rentea RM, Aichner J, Szavay P. Surgical Simulation of Posterior Sagittal Anorectoplasty for Rectovestibular Fistula: Low-Cost High-Fidelity Animal-Tissue Model. J Pediatr Surg. 2023;58(10):1916-1920. doi:10.1016/j.jpedsurg.2023.02.055
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