Evaluating the role of the 'Accessible Novel Solutions for Widespread Emergency Reconstructive Surgery' (ANSWERS) 3D-printed perineal training model for conflict-related sexual violence injuries.

Abstract

Conflict-related sexual violence (CRSV) causes considerable physical and psychological harm, often leading to complex urogenital injuries that require specialised reconstructive surgery. Despite the growing global demand for specialised surgical care, access to niche specialities and training resources remain limited, particularly in high-conflict and resource-constrained areas. This study evaluates the effectiveness of the Accessible Novel Solutions for Widespread Emergency Reconstructive Surgery (ANSWERS) 3D-printed model, developed in collaboration with the Panzi Foundation, as a training tool for urogenital fistula repair associated with CRSV. Conducted at Panzi Hospital in the Democratic Republic of Congo, this study employed a cross-sectional survey design involving 13 healthcare professionals. Participants engaged in hands-on practice with the 3D-printed model, creating and repairing simulated defects to closely replicate CRSV injuries. The survey assessed the model's anatomical fidelity, usability and impact on surgical preparedness, incorporating quantitative ratings and qualitative feedback. Our findings revealed strong support for the model's training value, with most participants reporting increased confidence in their technical skills. Areas for improvement due to limitations of anatomical detail and material durability were noted. Qualitative insights indicated that integrating the Panzi score-a classification system for fistula severity-and augmented reality or extended reality technology could enhance the model's relevance and interactivity. The study highlights the use of the ANSWERS 3D-printed model in building competency-based training protocols in CRSV care. Future refinements in the multilayered materials, novel bioengineering approaches to enhance biomimicry, anatomical accuracy based on CT scans and Panzi score classifications hold great potential. Ultimately, digital integrations could lead to the development of a standardised, immersive training curriculum that aligns with Panzi Hospital's holistic approach, improving surgical outcomes for CRSV survivors globally.