Expediting operational damage control laparotomy closure : iTClampTM vs suturing during damage control surgical simulation training

From National Research Council Canada

DOIResolve DOI: https://doi.org/10.1503/cjs.003415
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Name affiliation
  1. National Research Council of Canada. Aerospace
FormatText, Address
Proceedings titleCanadian Journal of Surgery
ConferenceTrauma 2015 - Trauma Association of Canada Annua; Scientific Meeting, Apr. 10-11, Calgary, Alberta
ISSN0008-428X
1488-2310
Volume58
IssueSupplement S1
PagesS30–S30
Abstract
Background: As recent innovations in informatic technology allow for specialist support to point-of-care (POC) providers, advanced interventions, such as damage control surgery (DCS), may be possible on the front lines. However, for non-surgeons suturing is a very complex procedural skill, and thus other operational laparotomy closure techniques are needed. Methods: The study was a head-to-head comparison of laparotomy closure in an anatomically realistic surgical training mannequin (the “Cut-suit”) following a perihepatic DCS packing exercise. After skin-only closure with either the iTClamp or suture, the primary outcomes were completeness of closure and time to close. Six board-certified surgeons performed the same task as 12 military medical technicians (MT) who were randomized to unsupported (n = 5; UMT) or remotely telementored (n = 7; RTM) with real-time guidance by a trauma surgeon. Results: No study participants were able to close the incision with sutures and 0.55 achieved closure with the iTClamp. iTClamp application was superior to suturing when examining length of incision closed (p < 0.001), percent of incision closed (p < 0.001) and time to close incision (p = 0.008). Surgeons outperformed the RMT and UMTs on percent closed (p = 0.001, p = 0.004) and length closed (p = 0.001, p = 0.004) when suturing. However, MTs performed as well as the surgeons when using the iTClamp. All participants preferred the iTClamp to suturing, thought it was easy to use and learn to use and was applicable to DCS. Conclusion: Laparotomy closure following DCS in an anatomically realistic surgical mannequin was readily performed by military medical technicians and trained surgeons. The iTClamp proved to be a faster and easier modality to achieve incision closure compared to suturing.
Publication date
LanguageEnglish
Peer reviewedYes
NPARC number23001297
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