Surgical Simulation Education

A simulation education effort by Dr. Mark Orringer aims to reduce leak complications associated with cervical esophagogastric anastomosis by practice and repetition.

Cervical Esophagogastric Anastomosis (CEGA) Simulator

“Blunt” transhiatal esophagectomy (THE) was repopularized in our initial University of Michigan Thoracic Surgery report on the operation in 1978, and since then the feasibility and greater safety of a cervical esophagogastric anastomosis (CEGA) over the traditional intrathoracic esophagogastric anastomosis firmly established. It is estimated that approximately 50% of esophagectomoies in the US are now performed using the transhiatal approach with CEGA. While a CEGA carries a lower risk of post-esophagectomy mediastinitis, it is associated with an average reported 12-14% leak rate, and nearly 50% of such leaks ultimately result in an anastomotic stricture and a poor functional result for an operation intended to provide comfortable swallowing. A CEGA leak is at least partly technically related and theorectically reducible with simulator practice.

A novel, low-cost, medium-fidelity simulated CEGA operative site has been engineered to offer hands-on practice of a stapled side-to-side CEGA. A simulation-based curriculum in the form of a narrated video of the procedure has been developed and accompanies the simulator.

To date, 7 University of Michigan thoracic surgery faculty and 8 thoracic surgery residents have evaluated the simulator’s fidelity using a 24-item survey, across five domains with a 5-point rating scale:

  1. Physical attributes
  2. Realism of materials
  3. Realism of experience
  4. Value
  5. Relevance
  6. Ability to perform specific key tasks

Simulator validity evidence and the curriculum were thus evaluated. There were no faculty/resident rating differences, both groups attesting to the realism and value of the simulator and the accompanying curriculum.

In an effort to further validate the above initial results, a multi-institutional study to assess the simulator by thoracic surgery faculty and residents at 5 other residency programs is currently underway.


Dr. Orringer

Mark B. Orringer, MD

Cameron Haight Distinguished University Professor
Thoracic Surgery Section
Taubman Center
1500 E. Medical Center Drive
Ann Arbor, MI 48109