Gentle Tissue Handling Skills

This skills training module allows medical officers (non-specialist physicians) and general surgeons to become confident and competent in the gentle handling of delicate infant tissues as part of neonatal colostomy procedures performed in low to middle income countries (LMICs).

Learning Objectives

The learner should already have basic suturing skills for this skills training module.

By the end of this module, learners will be able to perform the following skills during a neonatal colostomy procedure:

• Gentle and delicate tissue handling
• Avoiding crushing tissue
• Avoiding tight sutures
• Avoiding undue tension and pull

Simulator Materials

The Neonatal Enterocutaneous Anastomosis Simulator requires the following components:

• 1 reusable cup with clean water
• Cigarettes (minimum of 10 for this skills training module)
• 4-0 or 5-0 silk sutures with a round bodied (tapered) needle (NOTE: 4-0 or 5-0 Vicryl or PDS sutures with a round bodied needle should be used during the actual procedure on live patients. Inexpensive silk sutures are recommended for use in this module's simulation training to maximize affordability and accessibility for learners.)
• Smooth (non-toothed) dissecting forceps
• Standard needle driver
• Mayo scissors (used to cut sutures and stabilize the proximal end of the cigarette closest to you)

Training Logbook

See Colostomy in Newborns/Training Logbook

Other Equipment

• Cellphone Camera

Gentle Tissue Handling Skills Training Using the Neonatal Enterocutaneous Anastomosis Simulator

1. Place the Mayo scissors on the proximal end of the cigarette closest to you to stabilize it
2. Suture the dry filter ends of two cigarettes together using 4-0 or 5-0 silk sutures, taking care not to tear or squash the cigarettes
3. Each stitch should have 4 throws for a secure bowel anastomosis
4. Place 4 interrupted sutures equally spaced apart circumferentially
5. If unsuccessful, the procedure is repeated at the same session or at other convenient times until successful suturing is achieved
6. If successful, complete the checklist in the Training Logbook and take a photo of the sutured cigarettes on your cellphone
7. Once successful with the dry filter ends of the cigarette, move to the next stage

1. Briefly dip the filter end of two cigarettes in water for 1 second to make them wet
2. Allow the filter ends to dry slightly so they are moist but not soggy
3. Place the Mayo scissors on the proximal end of the cigarette closest to you to stabilize it
4. Suture the two wet ends together using 4-0 or 5-0 silk sutures, taking care not to tear or squash the cigarettes
5. Each stitch should have 4 throws for a secure bowel anastomosis
6. Place 4 interrupted sutures equally spaced apart circumferentially
7. If unsuccessful, the procedure is repeated at the same session or at other convenient times until successful suturing is achieved
8. If successful, complete the checklist in the Training Logbook and take a photo of the sutured cigarettes on your cellphone
9. Once successful with the wet filter ends of the cigarette, move to the next stage

1. Place the Mayo scissors on the proximal end of the cigarette closest to you to stabilize it
2. Suture the dry lighting ends of two cigarettes together using 4-0 or 5-0 silk sutures, taking care not to tear or squash the cigarettes
3. Each stitch should have 4 throws for a secure bowel anastomosis
4. Place 4 interrupted sutures equally spaced apart circumferentially
5. Repeat Steps 1-4 on two additional pairs of cigarettes for a total of 12 consecutive sutures on the lighting ends for a total of 3 pairs of dry cigarettes
6. If unsuccessful, the procedure is repeated at the same session or at other convenient times until successful suturing is achieved
7. If successful, complete the checklist in the Training Logbook and take a photo of the sutured cigarettes on your cellphone.

When the learner has successfully completed a minimum of 12 consecutive sutures on the dry lighting ends on a total of 3 pairs of cigarettes, then they will have practiced to a sufficient level of mastery to perform a colostomy procedure in a neonatal patient.

Once successful with the dry lighting ends of the cigarette, the learner can choose to further develop their gentle tissue handling skills in this optional expert skills training activity.

1. Briefly dip the lighting ends of two cigarettes in water for 1 second to make them wet
2. Allow the lighting ends to dry slightly so they are moist but not soggy
3. Place the Mayo scissors on the proximal end of the cigarette closest to you to stabilize it
4. Suture the two wet ends together using 4-0 or 5-0 silk sutures, taking care not to tear or squash the cigarettes
5. Each stitch should have 4 throws for a secure bowel anastomosis
6. Place 4 interrupted sutures equally spaced apart circumferentially
7. Repeat Steps 1-6 on two additional pairs of cigarettes for a total of 12 consecutive sutures on the wet lighting ends for a total of 3 pairs of cigarettes
8. If unsuccessful, the procedure is repeated at the same session or at other convenient times until successful suturing is achieved
9. If successful, complete the checklist in the Training Logbook and take a photo of the sutured cigarettes on your cellphone