eP430 - Novel EEA Circular Stapler Simulator - A Needs Assessment

Purpose/Background: The ability to fire a circular EEA stapler is a skill in which all residents graduating from general surgery residency are expected to be proficient. However, the firing of an EEA stapler intra-operatively is a critical portion of the case often reserved for staff. Our aim was to understand the level of experience and familiarity residents are receiving in their training in terms of successfully firing an EEA stapler and completing an EEA anastomosis.Methods/Interventions: A 10 question survey was distributed to current general surgery residents from a single institution. The survey questions were designed to determine residents' operative experience with EEA anastomoses and EEA staplers as well as their familiarity and comfort with utilization of the technology. Qualitative analysis of the survey results was then performed.Results/Outcomes: A total of 29 residents across all PGY years responded. 62% of respondents reported that they have been involved 5 or more cases involving an EEA anastomosis, however, only 26% of those who have scrubbed a case with an EEA anastomosis had fired an EEA stapler 5 or more times. 26% of respondents had never fired an EEA stapler despite being involved in cases with an EEA anastomosis. No interns or second year residents had fired a stapler. 20% of chief residents had never fired a stapler. Only residents who had scrubbed greater than 5 cases with an EEA anastomosis had ever fired an EEA stapler. When trainees did not fire the stapler, it was usually the operative staff or another staff who was called into the room to help with the anastomosis that fired the stapler. When asked why they felt they weren't allowed to fire the stapler, the most common responses were a high risk anastomosis with no margin for error or the resident was unfamiliar with the stapler and had never fired an EEA before.When asked if they knew how to fire an EEA stapler, only 56% of respondents said probably yes or definitely yes, with confidence increasing with PGY year. Further, when tested to see if they could correctly order the steps of an EEA anastomosis, only 9 residents (31%) named the correct sequence. When asked if an EEA stapler simulator would be of benefit, 92% of residents responded probably yes or definitely yes.Conclusion/

Discussion: While experience firing an EEA stapler was shown to increase with operative exposure to EEA anastomoses, there were still a significant number of residents who had not been given the opportunity to fire a stapler. Furthermore, there was evidence of resident discomfort and unfamiliarity in the steps of an EEA anastomosis. Informed by our needs assessment, a colorectal EEA stapled anastomosis simulator -- The RELAX Trainer (Rectal Excision Low Anastomosis Task Trainer) -- has been created and is undergoing validation studies as a high fidelity model for simulated colorectal circular EEA stapled anastomoses."Figure 1. Operative Experience of General Surgery Residents Firing EEA Stapler Stratified by PGY Year

Number of self-reported instances that each resident who responded to the survey has fired an EEA stapler on live tissue in the operating room
Figure 2. Example of Completed Circular EEA Anastomosis on Task Trainer

Inferior is the rectal stump that was divided with a TA stapler, more superiorly is the EEA circular anastomosis. The rectum is 3-D printed and made of silicone."