Validation of low-cost models for minimal invasive surgery training of congenital diaphragmatic hernia and esophageal atresia

Abstract

Minimal invasive surgery Low budget models Congenital diaphragmatic hernia Esophageal atresiaBackground: Minimal invasive surgery (MIS) is increasingly used for the correction of congenital diaphragmatic hernia (CDH) and esophageal atresia (EA). It is important to master these complex procedures, preferably preclinically, to avoid complications. The aim of this study was to validate recently developed models to train these MIS procedures preclinically. Methods: Two low cost, reproducible models (one for CDH and one for EA) were validated during several pediatric surgical conferences and training sessions (January 2017-December 2018), used in either the LaparoscopyBoxx or EoSim simulator. Participants used one or both models and completed a questionnaire regarding their opinion on realism (face validity) and didactic value (content validity), rated on a five-point-Likert scale. Results: Of all 60 participants enrolled, 44 evaluated the EA model. All items were evaluated as significantly better than neutral, with means ranging from 3.7 to 4.1 (p b 0.001). The CDH model was evaluated by 48 participants. All items scored significantly better than neutral (means 3.5-3.9, p b 0.001), with exception of the haptics of the simulated diaphragm (mean 3.3, p = 0.054). Both models were considered a potent training tool (means 3.9). Conclusion: These readily available and low budget models are considered a valid and potent training tool by both experts and target group participants.

Diagnostic Value of Prenatal Ultrasound Parameters and Esophageal Signs in Pouch and Lower Thoracic Segment in Fetuses with Esophageal Atresia

“…Tracheoesophageal fistula is formed between the distal esophagus and trachea, and the distal esophagus is often dysplasia with thin wall and thin lumen [ 21 ]. Type I EA is characterized by atresia of both the proximal and distal esophagus with a long distance between broken ends, and the proximal esophagus may also form a pouch, while the distal blind end of the esophagus is mostly located above the diaphragm level and often accompanied by dysplasia [ 22 ]. The esophagus is a hollow pipe connecting pharynx and stomach and an important part of the digestive system.…”

The “chicken-leg anastomosis”: Low-cost tissue-realistic simulation model for esophageal atresia training in pediatric surgery

“…Indeed, the haptic component of the chicken skin was unanimously well appraised, consistently with previous studies on similar models ( 11 ). We believe that this constitutes a significant advantage to the synthetic models currently available ( 1 , 5 , 22 ), although the realism of a multilayered tissue is still missing.…”

“…Animal trainings are similarly expensive, other than hard to obtain and ethically questionable ( 8 ). Only a few low-cost trainers for specialized training in pediatric surgery are available with predominant artificial and mostly unrealistic tissue ( 5 , 9 , 10 ). Based on these premises, we decided to develop an easy access low-cost tissue-realistic simulation model for esophageal atresia on the basis of a chicken-leg pyeloplasty model published in 2006 ( 11 ) and evaluate its effect in enhancing the performance of trainees and junior attending pediatric surgeons.…”

Development and validation of a novel 3D-printed simulation model for open oesophageal atresia and tracheo-oesophageal fistula repair

“…The model was able to distinguish between experienced and inexperienced surgeons, with significantly fewer errors and manipulations, and a shorter time to complete the task, being observed in the experienced group. Similarly, Bökkerink and colleagues described a low-cost procedural model for OA repair without TOF, consisting of two rubber balloons separated on a suture pad inside a laparoscopic box trainer [10]. It was perceived as useful as a training tool, and scored 3.8/5 (± 0.8) for visual realism and 3.6/5 (± 0.8) for tissue haptics.…”