# Open Surgical Simulation in the Minimally Invasive Era: A Binational Bowel Anastomosis Training Program

## TL;DR

This study shows that a structured open surgery training program improves skills and confidence in performing bowel anastomosis.

## Contribution

The study introduces a binational open surgery training program with a reproducible evaluation system for bowel anastomosis.

## Key findings

- Participants reduced anastomosis time from 34 to 20 minutes with significant improvement in students and residents.
- Surgical skills scores increased significantly across all participants, with notable gains in students and residents.
- Permeability improved significantly, while perceived autonomy increased among students and residents.

## Abstract

Introduction: Acquiring surgical skills is a mandatory factor in a surgeon's training, with simulation being a key tool to achieve this goal. Laparoscopic technical simulation is widely evaluated and validated, relegating open surgery; moreover, most surgical centers do not have a structured training program. The aim of this study was to evaluate a binational training program for performing bowel anastomosis in open surgery using a reproducible evaluation system.

Methods: We conducted a quasi-experimental study involving 20 participants who were divided into four groups according to their level of training. Supervised sessions using inanimate models were carried out. Surgical skills (Objective Structured Assessment of Technical Skill (OSATS)), operative time, hermeticity and permeability, and perception of autonomy were evaluated using an ex vivo bovine model. Statistical analysis was performed using Chi2, t-test, and Wilcoxon rank-sum test with SPSS version 25.0 (IBM Corp., Armonk, NY, USA); significance was set at α < 0.05.

Results: The average time to complete an anastomosis decreased from 34 to 20 minutes for the entire sample (p<0.001), with the greatest improvement observed between students and residents (p<0.001). Surgical skills measured by OSATS score increased across all participants from 23.10 to 28.75 (p<0.001), with significant gains in students (p=0.04) and residents (p=0.04). Permeability improved significantly in the full cohort (p<0.02), while hermeticity showed no overall statistical difference. Perceived autonomy increased among students and residents.

Conclusions: This study supports the implementation of structured, simulation-based training programs in open surgery as an effective strategy to improve technical skills and confidence during surgical education. Despite the small sample size, these findings highlight the value of reinforcing open surgical competencies in the minimally invasive era.