A Mannequin Named FASTT Joins the Fight against Lymphatic Filariasis

By Mary Houghton  - June 29, 2016
Surgeons practice their skills on FASTT during pilot testing in Burkina Faso in June 2016. In the coming year, the four surgeons who participated – two from Burkina Faso and two from Ethiopia -- will serve as national hydrocelectomy master trainers in their countries. (Photo: Zeina Sifri)

Customs officials in Africa may be a bit surprised when they look inside several boxes due to arrive soon from the U.S. But the unusual cargo – a life-size model of a man’s groin, sans pantalons -- is for a good cause.

The Filaricele Anatomical Surgical Task Trainer, or FASTT, is an anatomically precise mannequin for use in training surgeons how to operate on men suffering from hydrocele, the severe swelling of the scrotum caused by the disease lymphatic filariasis.

Hydrocele occurs when filarial worms transmitted by mosquitos lodge in the lymphatic vessels of the scrotum, causing fluid to accumulate. In particularly acute cases, the enlarged scrotum may hang down to the knees.

It’s not hard to imagine the disability and shame suffered by men with hydrocele. Studies have documented their inability to move freely due to pain, their embarrassment at appearing in public, their undesirability as marriage partners, and even their rejection by wives. And when hydrocele robs men of their ability to work, the economic blow can extend to families and communities.

Perhaps more surprising is how many men are affected. A World Health Organization-designated neglected tropical disease, lymphatic filariasis is almost unheard of in more northern latitudes but relatively common across broad swaths of Africa and Southeast Asia. According to the World Health Organization, an estimated 25 million men worldwide are living with filarial hydrocele.

Fortunately, a treatment exits. Through a surgical procedure known as hydrocelectomy, the fluid can be removed and the scrotum permanently returned to its normal size. With generous funding from USAID, the MMDP Project is supporting national efforts to eliminate lymphatic filariasis in three endemic countries. The project’s support will help countries train surgeons to perform high-quality hydrocelectomies and increase access to surgery, so that no man need endure the disability and stigma of hydrocele.

On a workbench at development firm Human Analogue Applications, a FASTT prototype sports a scrotal cartridge into which water is pumped to create an internal hydrocele. (Photo: Jim Johnson)

The FASTT mannequin, developed by the MMDP Project, is a crucial part of the effort. Under the project, medical professionals will be trained or retrained to perform hydrocelectomies through a curriculum that includes theoretical instruction by a master hydrocele surgeon, a video showing each step of the surgical process, practice sessions on FASTT, and -- only after surgical skills are satisfactorily demonstrated on the mannequin -- supervised surgery on a live patient.

Expert surgeons who pilot tested FASTT in Burkina Faso in June 2016 said the tool fills a major gap in hydrocelectomy training. “The mannequin is real bridge between the purely theoretical aspects of hydrocele surgery and the operating room,” said Dr. Guira Adama, head of surgery at Nano Medical Center in Burkina Faso.

“It allows the surgeon to switch from theory to practice first on inert material, practice which will make him or her more competent and more experienced before operating on a living person. It bridges a gap in the sense that something was missing, because [before] the surgeon was switching from theory to the operating room with a lack of self-confidence. With the practice on the mannequin, this lack of confidence will be greatly mitigated,” he said.

Feedback from the surgeons who pilot tested FASTT has led to certain modifications, with rollout of the final design expected in July 2016 and use of the mannequin in training programs planned throughout the coming year.

USAID’s and the MMDP Project’s ultimate goal is to see the FASTT mannequin become a permanent addition to national hydrocele surgery training programs, enabling health systems to address emerging cases of hydrocele with high-quality surgery over the long term.

One person already thinking ahead to long-term uses of FASTT is pilot-test participant Dr. Andualem Deneke, secretary general of the Surgical Society of Ethiopia and a surgical urologist at Addis Ababa University.

Besides being “a very good tool for training beginners, like general practitioners,” he said, “FASTT will be wonderful also for training medical students in their final year of study, making it a tool for sustainable training of hydrocele surgeons in the tropics.”

Mary Houghton is the Communications Specialist for the MMDP Project.

Correction: The original version of this article has been edited to reflect a change in the name of the surgical training tool. Formerly called FAST (Filaricele Anatomical Surgical Trainer), the tool is now known as FASTT (Filaricele Anatomical Surgical Task Trainer).