The Summa SILS Inanimate Trainer Box Top

Christopher M Kriebel, BS, Bhavik Shah, BS, Michelle Evancho-Chapman, BS, Tristan L Ula, BS, Mark Pozsgay, DO, John G Zografakis, MD FACS. Summa Health System- Akron City Hospital, Akron OH, USA

Moving from multiple ports in the abdomen to a central port in the umbilicus may in fact improve cosmesis and reduce post operative pain/length of stay, nevertheless, it radically changes the technique used to perform the surgery. There is a definitive learning curve associated with any advancement in technology and/or change in technique. Studies have demonstrated that surgical training and education outside of the operating room (OR) significantly benefits a surgeon’s operative performance. Currently, there are no Single Incision Laparoscopic Surgery (SILS) simulation trainers available. We have designed a training simulator that is capable of replicating the SILS procedures outside of the OR.

Surgical residency programs across the country utilize the Fundamentals of Laparoscopic Surgery (FLS) trainer box for simulation training in laparoscopic surgery. By removing the PVC membrane on the FLS Box, our device, the Summa SILS Inanimate Trainer Box Top, is positioned in its place. This device consists of two critical components, the box top and the artificial tissue. The following material was chosen to simulate the skin, fascia, and peritoneum; a 1/8” piece of head liner fabric, a piece of 7/8” simulation tissue, and a 1/16” piece of adhesive-back medium-strength neoprene rubber, respectively. Using two aluminum plates 4 7/32” x 4 7/32” machined with a 3 47/64” diameter circular centers we were able to both integrate a sterile field and attach the artificial tissue to the box top. One plate mounts on the superior surface of an 11 13/64” x 15 13/64” laminated board, while the other acts as the locking plate for the tree layers of tissue to the inferior portion of the board. Once the material is mounted to the box top, two 20.5 degree angled pieces of laminated board are secured using industrial strength Velcro which attaches to the FLS unit, as to replicate the abdominal rigidity and position of an OR patient.

The trainee will then follow protocol for SILS Port access and insertion. Once they have gained access, they will be able to complete a series of tasks ranging from basic skills to advanced procedures designed to replicate conditions encountered in the OR. These skills include, but are not limited to a modified FLS style peg transfer task, clipping and cutting a Penrose drain that has been set up to resemble the cystic duct and artery, and a FLS style pattern cutting task.

Patient care is a major initiative not only at Summa Health Systems, but at other institutes around the world. A clear-cut way to improve patient care is to start with the providers. The SILS Inanimate Trainer Box top is a teaching tool designed to eliminate the patient from being part of the learning curve, while assisting the residents in gaining the surgical dexterity and skill they will need in the OR. The future direction of this technology will be to establish a standard of proficiency capable of measuring a resident’s/physicians aptitude to utilize SILS techniques prior to operating on a patient.