A Low Cost Emergency Laparotomy Task Trainer for Major Abdominal Bleeding: An Option for Surgical Residents to Learn Lifesaving Basic Surgical Skills

Abstract

Objective: To instantly stop life threatening abdominal bleeding (e.g., a ruptured abdominal aneurysm), every surgeon should be familiar with the principles of emergency laparotomy (EL) and aortic clamping. Simulation training in a safe environment can be used to rehearse these situations like other medical emergencies. Owing to the lack of a suitable commercial simulator, a homemade task trainer was constructed. This study aimed to evaluate the feasibility of an EL simulation training course among surgical residents using this low cost task trainer. Methods: To enable simulation training for massive abdominal bleeding with subsequent EL and aortic clamping, a multiprofessional team developed an EL task trainer. A structured evaluation of the trainer and its applicability was performed by external consultants, who tested the trainer themselves. Instructions for constructing the trainer were created and costs were calculated. During the EL simulation course targeted for surgical trainees early in their careers, 34 participants familiarised themselves with EL. Their experiences of the feasibility of the course and increase in self assessed clinical competence in managing the situation were studied using a questionnaire. In a subgroup of trainees, the simulation was compared with a real life EL subsequent to the course. Results: Participants found that the trainer was fit for its purpose (mean score, 4.7 out of 5). Their self assessed clinical competence increased in several domains: EL as a procedure (p < 0.01), handling of intra-abdominal tissues and organs during EL (p = 0.008), and emergency procedures in intra-abdominal haemorrhage (p < 0.001). The cost for the body of the trainer was €108 and there was an additional €42 for the disposables for one training scenario. Conclusion: A low cost task trainer with pulsatile flow enabling surgical residents to rehearse EL with aortic clamping can be constructed from commonly available materials. Preliminary experience of its feasibility and effects on learning in a simulation training course have been positive.

Keywords

• Abdominal access
• Aortic clamping
• Cost
• Emergency laparotomy
• Simulation training
• Task trainer