Less is more: creation and validation of a novel, affordable suturing simulator for anorectal surgery

S. J. Langenfeld, M. A. Fuglestad, K. G. Cologne, J. S. Thompson, C. Are, S. R. Steele

Research output: Contribution to journalArticlepeer-review

2 Scopus citations


Background: Duty hour restrictions have increased the role of simulation in surgical education. A simulation that recreates the unique visual, anatomic, and ergonomic challenges of anorectal surgery has yet to be described. The aim of this study was to develop a low-cost, low-fidelity anorectal surgery simulator and provide validity evidence for the model. Methods: A novel, low-fidelity simulator was constructed, and anorectal surgery workshops were implemented for general surgery interns at a single institution. Face and content validity were assessed with separate questionnaires using a 5-point Likert scale. Participants performed a simulated hemorrhoid excision with longitudinal wound closure, and transverse wound closure. Time-to-task completion and quality of suturing/knot tying were evaluated by a blinded observer to assess construct validity. Results: Material cost was US $11 per simulator. We recruited 20 first-year surgery residents (novices) and 4 practicing colorectal surgeons (experts), and conducted 3 workshops in 2014–2016. All face and content validity measures achieved a median score greater than 4 (range 4.0–5.0). Time-to-task completion was significantly lower in the expert cohort (hemorrhoid excision with longitudinal wound closure: 195 vs. 477 s and transverse closure: 79 vs. 192 s, p < 0.001 for both). Suturing and knot-tying scores were significantly higher in the expert cohort for both tasks (p < 0.05 for all comparisons). Conclusions: Our low-fidelity, low-cost anorectal surgery model demonstrated evidence of face, content, and construct validity. We believe that this simulator could be a useful instrument in the education of junior surgical trainees and will allow residents to obtain proficiency in anorectal suturing tasks in conjunction with traditional surgical training.

Original languageEnglish (US)
Pages (from-to)1057-1064
Number of pages8
JournalTechniques in Coloproctology
Issue number11
StatePublished - Nov 1 2019


  • Anorectal surgery
  • Colorectal surgery
  • Hemorrhoidectomy simulation
  • Simulation-based education

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology


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