High-fidelity simulation model for the posterior sagittal anorectoplasty in anorectal malformations with rectovestibular and rectourethral fistula

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BACKGROUND: Surgical training for posterior sagittal anorectoplasty (PSARP) in anorectal malformations is limited by the rarity of the condition and restricted operative exposure. Existing low-cost simulators facilitate learning of procedural steps but lack realistic tissue characteristics and anatomical fidelity. METHODS: A high-fidelity animal-tissue simulation model was developed using poultry slaughter by-products. The model combines the perineal anatomy of a chicken with a segment of turkey esophagus to recreate multilayer tissue structures and simulate rectovestibular and rectourethral fistulae. Model construction and surgical simulation were designed to reflect the standardized operative steps for PSARP defined by international consensus. RESULTS: The model reproduces layered anatomy, tissue adhesions, and haptic properties relevant to the PSARP dissection. Surgical simulation enables trainees to perform the key 11 surgical dissection steps of the consensus operative framework. Steps related to patient positioning, preoperative genitourinary endoscopy, and sphincter stimulation cannot be simulated. The model is inexpensive and reproducible. CONCLUSION: A poultry cadaver model provides a high-fidelity platform for simulation of PSARP in anorectal malformations with rectovestibular and rectourethral fistula. It may support structured surgical training and competency development in pediatric colorectal surgery.

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