A new surgical trainer (BOPT) improves skill transfer for anastomotic techniques in gastrointestinal surgery into the operating room: a prospective randomized trial

Abstract

Background: A multifunctional skill trainer (Berlin Operation Trainer, BOPT) allows realistic training of conventional gastrointestinal (GI) surgical techniques. The aim of this prospective randomized study was to evaluate the training success and the potential for transfer of anastomotic techniques in GI surgery into the operating room using the BOPT.

Methods: Thirty-six surgical residents and surgeons in their subspecialty fellowship were classified as novices and experts according to their surgical experience and randomized into either a group that trained on standard training devices (n = 19) or a group that trained on the BOPT (n = 17). The participants performed an intestinal anastomosis with a single-layer running suture with BOPT (+BOPT) or without BOPT (-BOPT) at the beginning (point in time 1, PIT 1) and at the end of 4 days of surgical training (PIT 2). To simulate a real operation, the anastomosis at PIT 2 was performed in the open situs of an intubated domestic pig. The performance of the intestinal anastomoses was documented with video and photos. The time to perform the anastomosis and the quality of the anastomosis technique (total enterorrhaphy score) were rated independently by two surgeons using 17 defined quality criteria.

Results: The +BOPT group was faster than the control group (-BOPT group) (operating time = 192.4 +/- 53.8 vs. 221.3 +/- 47.8 s; P = 0.064) and had a higher score (12.1 +/- 2.0 vs. 10.2 +/- 2.6 points; P = 0.032) at PIT 2. Participants with an improved video and photo enterorrhaphy score had trained more frequently with the BOPT (+BOPT group) (14/19, 73.7%; P < 0.0005). The participants in the BOPT group showed a significant improvement in performance from PIT 1 to PIT 2 with respect to speed (P = 0.049), the quality of the suture (video enterorrhaphy score; P = 0.026), the completed anastomosis (photo enterorrhaphy score; P = 0.021), and the total enterorrhaphy score (video and photo enterorrhaphy score; P = 0.039) compared to the control group without BOPT. There were no significant differences in improvement between novices and experts.

Conclusion: The training using the Berlin Operation Trainer (BOPT) with respect to training success and the potential to transfer to GI surgery the suture and anastomosis techniques learned seems to be significantly superior to standard surgery modules, independent of the surgeon's training status. The BOPT is a useful tool for training conventional gastrointestinal surgery techniques.