A novel cervical esophagogastric anastomosis simulator

Abstract Objectives At least partially technically related, a cervical esophagogastric anastomosis (CEGA) has a 12-14% leak rate which is theoretically reducible with simulator practice. Preliminary development and testing of a CEGA simulator is described. Methods A portable, low cost, scale reproduction of the CEGA operative site was engineered around a 19 x 11 x 6 cm plastic box. Silicone “esophageal” and “gastric tip” castings permitted construction of a stapled side-to-side CEGA guided by an illustrated curriculum. In a two-phase pilot study, the simulator and curriculum were evaluated. Phase 1: Seven faculty evaluated fidelity using a 5-point, 24-item survey of a) physical attributes, b) realism of materials, c) realism of experience, d) value, and e) relevance, and a sixth domain, (f) ability to perform tasks. Overall impression of the simulator was also measured. Phase 2: Eight thoracic surgical trainees similarly evaluated the simulator and the quality of the curriculum. Faculty and trainee ratings were compared using a Rasch model, and inter-rater agreement (ICC) estimated. Results There were no overall fidelity differences across faculty and resident ratings. Combined observed averages ranged from 4.52 (Realism of Materials) to 5.00 (Relevance). Lifelike feel of esophagus had lowest ratings (OA=4.40). Residents rated Interrupted outer layer of anterior closure to be more difficult (OA=4.13) than faculty (OA=4.86), p=.016, d=1.99. Global ratings (OA=3.33 out of 4.00) indicated participants believed the simulator could be used for CEGA training now, but could be improved slightly. Conclusions Preliminary evidence suggests the novel CEGA simulator is valuable as a surgical training tool.