Development and use of low-fidelity, low-cost, animal tissue-based simulators for surgical training during the Covid-19 pandemic

BACKGROUND The Covid-19 pandemic severely affected surgical training as the number of surgeries being done was reduced to a bare minimum. Teaching and training of clinical skills on a simulator are desirable as they may have an even larger role during the Covid-19 pandemic. Commercially available simulators with optimum fidelity are costly and may be difficult to sustain because of their recurring cost. The development of low-cost simulators with optimum fidelity is the need of the hour. METHODS We developed animal tissue-based simulators for imparting skills training to surgical residents on some basic and advanced general surgical procedures. Porcine tissue and locally available materials were used to prepare these models. The models were pilot-tested. Standard operating procedures were developed for each skill that was shared with the participants well before the ‘hands-on’ exercise. An online pre-test was conducted. The training was then imparted on these models under faculty guidance adhering to Covid-19-appropriate behaviour. This was followed by a post-test and participant feedback. The entire exercise was paperless. RESULTS Sixty residents were trained in 10 sessions. Most of the participants were men (44; 73%). The mean pre-test and post-test scores were 40.92 (standard deviation [SD] 6.27) and 42.67, respectively (SD 4.06). Paired sample t-test suggested a significant improvement in the post-test score (p<0.001). The activity and the models were well appreciated by the residents. CONCLUSION The animal tissue-based indigenous models are easy to prepare, cost-effective and provide optimum fidelity for skill training of surgical residents. In addition to skill acquisition, training on such modules may alleviate the stress and anxiety of the residents associated with the loss of surgical training during a time-bound residency period.

Portfolio-based Learning and Assessment.

Assessment using portfolios has recently gained wider acceptance, and is being considered relevant to several educational aspects in medicine, including formative and summative assessment during resident training, revalidation and continuing professional development. In this article, we provide an overview of the use of portfolio as an assessment and learning tool. We have discussed the rationale of using portfolio in medical education, its advantages and criticisms, and some of the associated challenges and dilemmas.

Role of suture material and technique of closure in wound outcome following laparotomy for peritonitis.

Background: There are no accepted guidelines for the closure of laparotomy incisions in patients of peritonitis. As these patients differ from the patients undergoing elective abdominal surgery, the same recommendations for closure may not be applicable in both groups. Aim: To compare wound outcome parameters following closure of the laparotomy incision with absorbable and non-absorbable suture material using the continuous and interrupted techniques in patients of peritonitis. Method: A single blinded randomised controlled trial using Polygalactin–910 and Polypropylene, number 1 sutures, to close midline vertical incisions, placed in continuous and interrupted manner, was performed on 174 patients. Patients were randomised into four groups: Group A (Polygalactin-910 continuous suturing, n=40), B (Polygalactin-910 interrupted suturing, n=47), C (Polypropylene continuous suturing, n=45) and D (Polypropylene interrupted suturing, n=42). The incidence of wound infection, dehiscence, suture sinus formation and incisional hernia was recorded. Patients were followed up for a period of four years. Statistical analysis involved the chi-square and Fisher’s exact tests. A ‘p’ value of <0.05 was considered significant. Results: The study included 139 male and 35 female patients between the ages of 10 and 75 years. The incidence of wound infection (p=0.656), dehiscence (p=0.997), and incisional hernia (p=0.930) at 3 months and four years (p= 0.910) was not statistically significant. There was no sinus formation in groups A and B, however 2 patients of group C and 6 patients of group D did develop suture sinus (p=0.003). Conclusion: Suture material and technique of closure does not influence wound outcome in patients of peritonitis except for a significantly lower incidence of sinus formation when non-absorbable sutures are used.

Plasticobezoar-another new entity for Rapunzel syndrome.

Rapunzel syndrome- a form of trichobezoar occurs when a gastric trichobezoar extends beyond the pylorus into the bowel. We report two cases of Rapunzel syndrome, one of them caused by ingestion of plastic material, so as to name it as a 'Plasticobezoar'. To the best of our knowledge no Rapunzel syndrome due to this material has been reported so far.

Unusual rectal stricture.

The aetiology of rectal stricture is varied, with malignancy being the commonest cause. We report the case of a 26-year-old man, from the state of Bihar, India, who presented with features of large bowel obstruction. Investigations revealed a rectal stricture. Biopsy from the affected site demonstrated non-specific inflammation. An anterior resection was carried out as it was not possible to convincingly rule out malignancy. Histopathological examination of the resected specimen reaffirmed the nonspecific inflammation. This case illustrates that long stricture of rectum my have a benign cause.