Arterial Anastomosis Recipe

"Our anastomosis model is easy to construct, can be used multiple times, and accomplishes the same objectives stated in the ACS/APDS Surgical Skills Curriculum, using items from the operating room (OR), home improvement store, and online. Objectives: 1- Provide trainees with a low cost, mid-fidelity model on which to practice vascular anastomoses in our skills lab. 2- Design a model to effectively bridge the gap between transplant and vascular surgery faculty expectations and resident proficiency in vascular suturing. 3- Provide a means for vascular surgical faculty to teach vascular surgical technique in a way that accommodates busy schedules. Outcomes: Since the creation of our low cost model series, this model is one that has had the highest utilization. Residents and faculty have both appreciated the increased preparation that it has provided for residents going into the OR. Once finished, if the resident does not like their work, they simply cut the ¼" Penrose drain off, move the towels over, and try again. The results are a string of anastomoses along the 1" Penrose drain, allowing residents and faculty to critique, evaluate, and visualize consistent error or progressive improvement. Used as an introductory step for our Deep Anastomosis Model, residents can learn and master vascular surgical technique on a flat surface before trying to perform it in a hole.The Surgery Sim Lab is part of the Utah Center for Innovation and Simulation in Education (U-CISE) is an American College of Surgeons Accredited Education Institute (ACS-AEI). This accreditation places U-CISE in the company of 80 other surgical simulation centers in the United States, and denotes excellence in the development, delivery, and evaluation of surgical education programs. Many of the tools used by residents at U-CISE were developed in the center to make teaching more cost effective - while improving training opportunities. Ruth Braga, R.N., M.S.N., nurse educator in the Department of Surgery developed and built suturing practice blocks for a fraction of the cost of those available commercially."

UNIVERSITY OF UTAH SURGICAL SKILLS LAB ARTERIAL ANASTOMOSIS MODEL Revised 3/2014 1 Model/2 Residents SUPPLIES NEEDED: MODEL: 1-1/4" Penrose drain 1-1" Penrose drain 1-Small blue plastic surgical tray from OR packs 2-Small office clips 1-Blue towel for base 4-Blue towels for draping 3-4 4"x4" tiles for weight 1-Skin Stapler Orange or Red permanent marker (for contrast) INSTRUMENTS: 1-Gerald or Debakey Forceps 1- Castro Needle Holder 1-Potts Scissors 1-Metzenbaum Scissors 2-Mosquitos w/Rubber Shods 1-#11 Blade 1-Knife Handle SUTURE: 5-0 Prolene double-armed INSTRUCTIONS TO BUILD: 1. Gather supplies 2. Place 3 or 4 tiles on blue tray to provide weight/keep tray from sliding 3. Lay towel across base of tray 4. Attach 1" Penrose to each long side of the tray with black clips 5. Color Penrose with permanent marker to provide contrast 6. Block drape and use skin stapler to create a window showing the Penrose drain 7. Place ¼" Penrose perpendicular to first Penrose (if desired, can use additional clip to clamp it to edge of tray) 8. When one resident has completed the anastomosis, cut ¼"Penrose just above suture line and move block drape over to expose new portion of 1" Penrose for the next resident CAN BE USED FOR: ACS/APDS Surgical Skills Curriculum for Residents-Phase 1 Module 11: Arterial Anastomosis Peter Bartline MD, Ruth Braga MSN, William Peche MD, Daniel Vargo MD. Click here for more Sim Lab recipes online.