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Surgery Sim Lab Recipes

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.
Arterial Anastomosis Model

 

Arterial Anastomosis Model:
Arterial Anastomosis Sim Guide .pdf
Arterial Anastomosis Recipe .pdf

Model developed by: Peter Bartline MD, Ruth Braga MSN, William Peche MD, Daniel Vargo MD.

ARTERIAL ANASTOMOSIS iconArterial Anastomosis Sim Kit 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.

Suture Block Model

 

Suture Block Model Documents:
Suture Block Model Ingredient List pdf
Suture Block Model photo layout pdf
Suture Block Modle photos and list pdf

Model developed by: Peter Bartline MD, Ruth Braga MSN, William Peche MD, Daniel Vargo MD.

Suture Block Model icon graphicSuture Block Model Suturing is one of the most commonly taught skills in surgery. This demand makes model durability one of the most important features. After trying multiple commercial models priced at $25/piece, we developed this low cost version from simple items. 25 models lasted the full academic year, and served eight rotations of medical students and residents for less than the cost of two commercial models!

To properly create layers of skin, stabilizing fabric is used. It provides a firm layer on each side of a cushioned layer and can be purchased for <$8-enough fabric to create approximately 12 blocks. Coban cover the ends of each block to prevent slivers and were obtained in the OR. If prep sponges were not available (subcutaneous layer), we purchased a twin-size camping foam mattress and cut it down. Wood and Velcro were purchased from home improvement/office stores.

Outcomes:
Prior to using the low cost suture blocks, we were unable to allow medical students to take supplies home for practice. This model has allowed us to create enough suture blocks for students to check out for the duration of their clerkship, and still have enough available in the skills lab for resident or student practice. With a simple replacement of the material and foam layer, a new suture block is created. Also, it is not a significant financial loss if blocks are not returned at the end of the rotation. Feedback from students and residents alike is that the model is durable, realistically replicates the layers of the skin, and handles appropriately with instrumentation. Residents have lauded it as an excellent tool for medical student teaching.

A. V. Fistula Model

 

 

AV Fistula Model Documents:
AV Fistula Ingredient List
AV Fistula Photo Layout

Model developed by: Peter Bartline MD, Ruth Braga MSN, William Peche MD, Daniel Vargo MD.

A V Fistula icon graphicAV Fistula Model
1 Model/2 Students Needed

MODEL:
1-Kidney basin
1-18” x 1/4” Penrose drain-cut in half
Felt-cut 12cm x 20cm
Press n’ Seal-12cm x 20cm
Positioning foam piece-cut to size of kidney basin
Ioban 30cm x 16cm
Tiles (for weight)-2-4”x4” or 1-12”x12”
Rubber shelving grip-cut to size of tiles
Velcro for base of kidney basin
Sharpie marker

INSTRUMENTS:
#15 blade with handle
#11 blade with handle
2-Weitlander retractors
2-Debakeys forceps
1-Gerald forceps
1-Metzenbaum scissors
1-Potts scissors
1-Right angle clamp
1-Bulldog clamp
1-Castroviejo needle driver
3-Mosquitoes
4-Vessel loops
2-Rubber shods

SUTURE:
3-0 or 4-0 silk suture (tie)
5-0 or 6-0 prolene, double armed on a taper needle

INSTRUCTIONS TO BUILD:
1. Trace kidney basin face down onto foam; cut out
2. Place felt piece in base of kidney basin
3. Place 2 pieces of penrose running lengthwise, approx. ½” apart
4. Cover penrose and felt piece with Press n’ Seal
5. Place foam into kidney basin so it fits snugly
6. Cover foam with ioban
7. Place one piece of Velcro on base of kidney basin
8. Place other piece of Velcro on tiles
9. Glue rubber shelving to base of tiles

Clamp Tie and Surgery Bucket Model
 
 
This model can be used to build the Deep Vascular Anastomosis model and the Stapled Bowel Anastomosis model (deep practice).
Stapled Bowel Anastomosis video image

Deep Anastomosis video still image

Clamp Tie and Surgery Bucket Model Documents:
FIGURE OF 8-COMPILED PICS .pdf file
Surgical Bucket Ingred List-Shared .pdf file
Clamp and Tie Module-How To Build .pdf file
Clamp and Tie Module-PGY instructions .pdf file

Model developed by: Peter Bartline MD, Ruth Braga MSN, William Peche MD, Daniel Vargo MD.

 
Clamp and Tie Model icon graphicClamp and Tie Module
Goal: residents should be able to pass a silk tie atraumatically around a clamped structure and tie into a hole.

Clamp and Tie Module Instructions: (Can be completed solo or with partner):
1. Place right angle clamp on vessel (rubber band stump) to obtain hemostasis
2. Place silk tie on the end of mosquito
3. Pass tie around the back of the right angle (mosquito SHOULD NOT pass behind right angle)
4. Guide the suture around the toe of the right angle using the tip of the mosquito (“tip to tip”)
5. Tie a square throw towards the toe of the right angle
6. When snug, say “off” to your partner (imaginary or real) and they will remove the right angle
7. Throw two more square throws in opposite directions (remember, three total throws for silk suture)
8. Move down the row until all the vessels are tied

The Surgery Bucket Model: (The Surgical Bucket (SB) should be constructed in the following manner):
1. Cut a one-gallon milk or water jug in half
2. Glue, or Velcro the bucket on a board or tile (for weight/stabilization)

Label accordingly:
1. Sides have one hole lower-center and are labeled A, B, C, D
2. Each side has 4 holes, labeled 1-4
3. Base is lettered a-h with Velcro above letter

Bucket can be used for:
1. Stapled Bowel Anastomosis Model-for deep practice
2. Deep Vascular Anastomosis Model
3. Figure 8-Deep Suture Ligation Model
4. Clamp & Tie Model

DEEP VASCULAR ANASTOMOSIS MODEL

 

Deep Anastomosis video still image

Deep Vascular Anastomosis model documents:
DVA Ingredient List pdf file.
DVA-Deep Vascular Anastomosis Photo Layout pdf file.

Model developed by: Peter Bartline MD, Ruth Braga MSN, William Peche MD, Daniel Vargo MD.

Deep Vascular Anastomosis icon graphicDeep Vascular Anastomosis Model
1 Model/2 Residents

SUPPLIES NEEDED:
MODEL:
1-Plastic gallon jug cut to be approx. 6” tall
1-Base (could be wood board, surgical tray, etc.-anything to give stabilize)
1-1/4” x 18” Penrose drain, cut in half
3-4 Towels for draping

INSTRUMENTS:
Castroviejo needle driver
Potts scissor
Pair of long Geralds or Debakey forceps

SUTURE:
5-0 or 6-0 prolene

OPTIONAL BUT HELPFUL:
Personal loops
Headlight (biking or camping headlight works!)

INSTRUCTIONS TO BUILD:
1. Gather supplies
2. If making the ‘surgical bucket’ for the first time, take an empty water or milk gallon jug and cut it in half, just below the handle
3. Using fine-tipped scissors (you don’t want a large hole), place a hole on opposite sides of the jug, approximately 1.5” up from the base
4. String the ¼” Penrose drain through each hole, so the Penrose is pulled across, taut.
5. Fix gallon jug to tiles or a board-anything heavy to provide stability. Use Velcro, a hot glue gun-anything to fix it to a solid or heavier surface.
6. Place the second ¼” Penrose across the drape so that it hangs perpendicular to the Penrose drain at the base.
7. As you can see in the picture layout, we used a red piece of paper in the base of the jug to provide contrast and better visibility, but this is not necessary
8. See the Photo Layout for additional tips/suggestions

HANDSEWN BOWEL ANASTOMOSIS MODEL

 

Handsewn Bowel Anastomosis model documents:
Handsewn Bowel Anastomosis Ingredient List pdf file
Handsewn Bowel Anastomosis Photo Layout pdf file

Model developed by: Peter Bartline MD, Ruth Braga MSN, William Peche MD, Daniel Vargo MD.

handsewn bowel anastomosis icon graphicHandsewn Bowel Anastomosis Model
1 Model/2 Students

SUPPLIES NEEDED:

MODEL:
1-1”x18” Penrose drain cut in half
1-Small blue plastic surgical tray from OR packs
2-Small office clips
1-Blue towel for base
4-Blue towels for draping
2-Pieces of felt fabric 2 ¾” x ¾” per resident
3-4 4”x4” tiles for weight
1-Skin Stapler
Any suture
Craft Scissors
Needle holder

INSTRUMENTS:
2-Toothed debakeys
1- Needle Holder
1-Scissor
2-Mosquitos

SUTURE:
3-0 Silk on SH/V-20
3-0 or 4-0 vicryl or PDS on a taper needle

INSTRUCTIONS TO BUILD:
1. Gather supplies
2. Mark the middle of the Penrose and cut in half
3. Cut 2 pieces of felt to above specified measurements
4. Tack ends of felt with suture so felt forms a circle
5. Place circle of felt on the inside ring of the Penrose-felt should fit perfectly inside Penrose without gaps or folding up on itself
6. Trim if necessary
7. Place 3 or 4 tiles on blue tray to provide weight/keep tray from sliding
8. Lay towel across base of tray
9. Attach Penrose to each long side of the tray so that ends with felt are matched up in the center of the tray
10. Block drape and use skin stapler to create a window showing only the felt-centered Penrose drain
11. When one resident has completed the anastomosis, use scissors to cut out completed portion.
12. Adjust portion of penrose with clip and insert new felt pieces for next resident

CAN BE USED FOR:
ACS/APDS Surgical Skills Curriculum for Residents-Phase 1 Module 19-Hand Sewn Gastrointestinal Anastomosis.

OPEN/CLOSE LAPAROTOMY MODEL

 

Open / Close Laparotomy and Laparoscopic Fundoplication Nissen model documents:
Exploratory LAPAROTOMY OPEN-CLOSE pdf document
Exploratory Laparotomy Photo Layout pdf document
Larparoscopic Fundoplication Nisssen Model Ingredient List pdf file

Model developed by: Peter Bartline MD, Ruth Braga MSN, William Peche MD, Daniel Vargo MD.

Open / Close Laparotomy model icon graphic OPEN/CLOSE LAPAROTOMY MODEL and LAPAROSCOPIC FUNDOPLICATION NISSEN MODEL
1 Model/2 Students Needed
ALLOW ADEQUATE DRY TIME

SUPPLIES NEEDED:

MODEL:
1-Blue plastic surgical basin
Variety of miscellaneous instruments to provide weight
Rubber shelving grip-enough to cover base of blue basin
1-strip of Ioban
Box of Glad Cling Wrap
Packing peanuts
Variety of gauze (or anything that can be used for packing space)
Spray Adhesive
3-Sponges from prep kits cut in half horizontally (along natural separation)
1-12”x12” piece of felt
1-12”x12” piece of vinyl covering
Glue Gun

INSTRUMENTS:
2-Toothed Debakey forceps
2-Mosquitoes
2-Retractors
2-Kochers
1-#10 blade
1-#3 handle
1-Needle driver
1-scissor

SUTURE:
#1 PDS (CT/CTX)

INSTRUCTIONS TO BUILD:
1. Gather supplies
2. Using glue gun, attach rubber shelving grip to base of blue basin so it does not slip
3. Place miscellaneous instruments in the base for weight. Cover and pack with gauze (about halfway up)
4. Lay piece of Press N Seal (stickier side facing up) on the inside of basin and pour packing peanuts into basin.
5. Wrap peanuts so it is about the size of a loaf of bread running down the middle of the basin.
6. Pack around ‘the loaf’ with other extra gauze (or other packing material)
7. Place a layer of Press N Seal over the blue basin, gauze and packing peanut ‘loaf’.
8. Place a 12”x12” piece of vinyl covering over Press N Seal-DO NOT glue vinyl to Press N Seal.
9. Spray vinyl with adhesive spray-place prep sponges one at a time on to vinyl, gluing edges together and pressing hard
10. Spray prep sponges with adhesive spray
11. Place a 12”x 12” piece of felt over the top of sponges
12. Wrap the model with a 12”x12” piece of ioban
13. Place heavy object on top of basin overnight preferably

OTHER RESOURCES:
ACS/APDS curriculum-Open/Close Laparotomy

—–
LAPAROSCOPIC FUNDOPLICATION NISSEN MODEL
1 Model/Resident

SUPPLIES NEEDED:
MODEL:
1-6”X 1.75” X 0.25” Industrial Styrofoam (can be purchased in large sheets for <$4 at Home Improvement stores)*
1-6”x1.75” Piece of Felt
1-1” Penrose cut down to 5” long
1-Chest tube container, cut to 5” long
1-3.5” x 1.75” In-Foam Stabilizer Fabric (round off edges)
1-2” strip Velcro
1-Skin Stapler

INSTRUMENTS/EQUIPMENT:
1-Endoscissors
2-Lap needle drivers
Lap skills trainer box and monitor

SUTURE:
2-0 Silk

INSTRUCTIONS TO BUILD:
1. Gather supplies
2. *Cut items to specified lengths
3. Use skin stapler to tack felt to foam to create felt base
4. Center Penrose in the middle of the felt base
5. With skin stapler, reach into Penrose and place a staple through the Penrose into the felt base (see photo #3)
6. Place fabric next to staple, lay Penrose over fabric and place a staple in the Penrose at the very edge of fabric so Penrose is securely anchored to felt base (see photo #4-6)
7. Fabric should fit snugly between the Penrose and felt base with little movement
8. Place chest tube container inside Penrose (simulates ‘Bougie’)
9. Put strip of Velcro on bottom of felt base
10. Affix to Velcro inside Lap Skills Trainer

CAN BE USED FOR:
ACS/APDS Surgical Skills Curriculum for Residents-Phase 2 Module 8: Laparoscopic Nissen Fundoplication

*Size/length note: Measurements are not firm and can be adjusted if desired. Felt should cover the top of foam at a minimum. Foam should not be thicker than ¼”. Chest tube container and Penrose should be cut to the same length or with the CT container slightly shorter.

STAPLED BOWEL ANASTOMOSIS (DEEP/SHALLOW) MODEL

 

STAPLED BOWEL ANASTOMOSIS model documents:
Stapled Bowel Anastomosis Ingredient List .pdf document.

Stapled Bowel Anastomosis video image

Stapled Bowel Anastomosis Photo Layout .pdf document.

Model developed by: Peter Bartline MD, Ruth Braga MSN, William Peche MD, Daniel Vargo MD.

STAPLED BOWEL ANASTOMOSIS icon graphicSTAPLED BOWEL ANASTOMOSIS (DEEP/SHALLOW)
1 Model/2 Students Needed

SUPPLIES NEEDED:

MODEL:
6-8 Elastics (Colored If Possible)
1-Red Rubber Or Clear Catheter (Approx. 12fr, cut to 10”-both ends removed)
1-1”X18” Penrose Drain
1 Piece Of Cotton Batting-Thin (Approx. 10”X8”)
1-Fine Tip Scissors
1-Ruler
1-Marking Pen
1 Can Spray Adhesive

FOR DEEP MODEL:
1-Plastic gallon jug cut to be approx. 6” tall
1-Base (could be wood board, surgical tray, etc.-anything to give stabilize)

FOR SHALLOW/TRAY MODEL:
1-Small blue surgical tray
2-Small black office clips
4-Blue surgical towels (cut as desired to drape model)
1-White Surgical Towel (To Place On Blue Tray Under Model)
3-4 4×4 ceramic tiles (placed in tray for weight)

INSTRUMENTS:
GIA stapler (one stapler or reload for each student)
TA stapler (one stapler or reload for each resident)
1-Needle driver
2-Debakey forceps
2-Mosquitoes
2-Tonsils
2-3 Allises
2-Tonsils
1-Right angle
1-Heavy Scissor
2-Bowel clamps

SUTURE:
3-0 Silk sutures 18”
2-0 Silk ties

INSTRUCTIONS TO BUILD:
1. Gather supplies
2. Use ruler to cut batting and catheter
3. Use marking pen to mark dots on catheter (one dot/elastic). Spacing is as desired.
4. Cut each elastic so it is a string
5. Tie one end of the elastic to the rubber catheter
6. Center Penrose drain so elastics extend upwards towards it-see picture
7. Using glue gun, place a dot on the base of the Penrose where it matches up with elastics and glue elastics to Penrose
8. With spray adhesive, place catheter in center of batting, spray, then fold batting up on top of itself.
9. Lay catheter in the center of batting so it folds in half up to the Penrose
10. Spray adhesive on the batting and fold in half, covering approximately ¼ of the base of the Penrose
11. Allow to dry

SET UP:
1. For deep model: place holes around base line (approx. 1.5” from base) of gallon jug. Lace Penrose through the holes
2. Anchor catheter to base (holes or stapling)
3. For flat model: using black clips, clamp Penrose to each side of the blue tray, giving some slack so bowel stands up

CAN BE USED FOR:
ACS/APDS Surgical Skills Curriculum for Residents-Phase 1 Module 20: Stapled Gastrointestinal Anastomosis