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Published Online 13 September 2017

A porcine model for teaching laparoscopic appendicectomy

Publication: The Annals of The Royal College of Surgeons of England
Volume 100, Number 4

Background

Synthetic models for teaching appendicectomy lack the realism afforded by the ‘feel’ of real tissue. Our low-cost, porcine-based model aligns more closely with real laparoscopic appendicectomy because it is responsive to the application of surgical energies.

Technique

Porcine tissue used to construct the appendix comprises an approximately 20-cm colon segment and a 7-cm segment of fallopian tube with mesosalpinx. The colon is inverted and ligated approximately 1 cm from the edge of one end. Eversion reshapes this into a caecal bulge. A perforation is created adjacent to the caecum and the fallopian tube is pulled into the lumen using long curved forceps, leaving about 5 cm of length outside, with the mesosalpinx. In low moisture, industrial superglue (CYN20, 100 cps viscosity, available from Everbuild Ltd. Leeds, UK) is used to spot-glue the base of the tube to the colon together with a single interrupted stitch here to safeguard against evulsion, while the mesosalpinx is spot-glued distally along the side of the lumen from the base (simulating the mesoappendix). The open distal tip of the fallopian tube is pinched closed with glue (Fig 1).
Figure 1 Staged model-building process

Discussion

This model has been used in the Royal College of Surgeons Core Skills in Laparoscopic Surgery course since its regional inception as an alternative to costly synthetics and cheaper, glove-based alternatives, which suit non-formal continuing training.1,2 Also used within the College Clinical Skills in Emergency Surgery course, it is mounted over a patient return electrode and set on a corkboard with board pins, enabling electrosurgical dissection. Mechanical vibration devices and laparoscopic scissors can also be used to dissect the mesosalpinx.

References

1.
Oliver JC, Carty NJ, Wakefield C. Low-cost model for laparoscopic appendicectomy in a webcam simulator. Bull R Coll Surg Engl 2010; 92 (4): 122–125.
2.
Shingler G, Ansell J, Goddard S et al. Piloting the ISCP Surgical Skills Assessment: the Wales Deanery experience. Bull R Coll Surg Engl 2013; 95 (1): 1–4.

Information & Authors

Information

Published In

cover image The Annals of The Royal College of Surgeons of England
The Annals of The Royal College of Surgeons of England
Volume 100Number 4April 2018
Pages: 338 - 339
PubMed: 29022814

History

Published online: 13 September 2017
Published in print: April 2018

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Authors

Affiliations

Welsh Institute for Minimal Access Therapy, Cardiff University School of Postgraduate Medical and Dental Education, Cardiff, UK
Warren N
Welsh Institute for Minimal Access Therapy, Cardiff University School of Postgraduate Medical and Dental Education, Cardiff, UK

Notes

CORRESPONDENCE TO Stuart Goddard, E: [email protected]

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