Effectiveness of a low-cost simulation model using animal tissue for training digestive anastomoses.

Abstract

Background: Simulation-based surgical training provides a safe environment for developing technical skills before operating on patients. In low-resource settings, however, access to high-fidelity simulators is limited. This study evaluated the educational effectiveness of a low-cost animal-tissue model using sheep intestine for teaching digestive anastomosis to surgical residents.

Methods: A prospective before-after study was conducted at the Department of Digestive and General Surgery, Traumatology and Great Burns Center, Ben Arous, Tunisia, from January 2023 to December 2025. Fifty-four residents attended a four-hour workshop combining demonstration, supervised practice, and structured feedback. Each performed two hand-sewn small-bowel anastomoses (end-to-end and side-to-side). Performance was assessed with the 7-item Objective Structured Assessment of Technical Skills (OSATS) scale. Operative time, leak testing, and self-assessment questionnaires (immediate and three-month follow-up) were analyzed using paired t-tests and McNemar's test (P<0.05).

Results: Mean OSATS scores improved from 18.9±3.2 to 28.1±3.6 (P<0.001; Cohen's d=2.1). The mean improvement was +9.2 points (95% CI [8.5-9.9]). Mean operative time decreased by ≈15minutes. Leak-free anastomoses rose from 55.6% to 100% (P<0.001). Satisfaction and realism scores were 4.8±0.4 and 4.6±0.5/5. At three months, 77.8% had applied the skills clinically and 66.7% reported increased confidence. Material cost was <6 € per trainee.

Conclusions: A procedural simulation using fresh sheep intestine is an effective, realistic, and affordable tool for teaching digestive anastomosis. It significantly enhances technical performance, efficiency, and confidence, supporting its integration into surgical curricula, especially in resource-limited environments.