Teaching Atraumatic Soft Tissue Handling in the Simulation Laboratory: Development of a Novel Training System

Abstract

Atraumatic soft issue handling is essential for optimal wound healing. Simulation is a safe and effective way to improve surgical skills outside the operating room. Our primary aim was the development of a pressure-sensing forceps that measures the force applied to a given tissue and provides real-time biofeedback. Seventy-eight students and trainees performed four trials of a continuous subcuticular closure using our Tissue Handling Trainer System device on a silicone skin model. We recorded the occurrence of above-threshold pressure and duration of time over the threshold. A one-way analysis of variance with Tukey post hoc test was used to analyze duration above-threshold pressure. There were statistically significant differences in the duration above threshold from trials 1 to 3 (P < 0.001). A 36% reduction occurred between trials 1 and 2 after participants learned of the study purpose, but a 70% reduction between trials 2 and 3 with audible feedback. There was no statistically significant difference between trials 3 and 4 (P = 0.807). The Tissue Handling Trainer System may be an effective technique for improving tissue handling skills in the surgical simulation laboratory.

Fig. 1.

Time over threshold by trial.

Fig. 2.

Normalized time over threshold per trial with respect to trial 1.