Development and Evaluation of a Mesh-Polyvinyl Alcohol Hydrogel Composite Small Bowel for Small Bowel Anastomosis Training.

Abstract

<h4>Introduction</h4>In surgeries requiring small bowel anastomosis, postoperative anastomotic leak is an infrequent (3.02%) but devastating complication associated with increased morbidity and mortality. Simulation continues to advance as a method of practicing surgical technique. Given the delicate nature of the small bowel, a high-fidelity simulated model is critical for ensuring skill acquisition and training transfer. However, the most commonly used models-porcine tissue and commercial synthetic analogs-present notable limitations, including environmental concerns, limited longevity, and mechanical properties that do not accurately represent human tissue.<h4>Methods</h4>This study aims to characterize and compare the mechanical properties of human, porcine, commercial off-the-shelf (COTS) tissue analogs, and a novel mesh-polyvinyl alcohol (PVA) hydrogel composite small bowel. Mechanical testing was conducted using a custom load frame (DEXTER) and uniaxial tensile tester to evaluate ultimate tensile strength, stretch ratio (SR), elastic modulus (EM), and suture pullout force (SPOF). In addition, 2 surgeons qualitatively evaluated the hydrogel simulant for its suitability for stapling and suturing, patency, and performance in anastomotic leak prevention.<h4>Results</h4>Compared with human tissue, porcine small bowel yielded a significantly different SPOF (P<0.001). The COTS synthetic small bowel exhibited significantly different EM (P<0.001) and SR (P<0.001). The hydrogel simulant tested similarly to human tissue with respect to tensile strength, SR, EM, and SPOF.<h4>Conclusion</h4>The novel hydrogel small bowel simulant exhibited mechanical properties that more closely resembled human small bowel compared with porcine or COTS models.