Validation of a Low-Cost Do-It-Yourself Model for Neonatal Thoracoscopic Congenital Diaphragmatic Hernia Repair

Abstract

Objective: We aimed to develop and validate a low cost, do-it-yourself model for neonatal thoracoscopic congenital diaphragmatic hernia (CDH).

Design: Volunteers with varying skills in neonatal minimally invasive surgery tested and evaluated the model simulating a neonatal thoracoscopic CDH repair. The model was built from ordinary materials purchased in a dime store: a small food container, a neoprene band simulating a diaphragm, an inflated balloon simulating a spleen, a tissue chord simulating intestine, and a body wash sponge simulating a collapsed lung. The evaluation comprised 3 sets of 5-point grading scale concerning appearance, necessary maneuvers, and ability to generate skills. Bowel reduction and suture efficacy was verified for each test.

Setting: Minimally invasive surgery simulation room at Pediatric Surgery Department of Hospital Universitario de Vall d'Hebron, Barcelona, Spain.

Participants: Volunteer residents and specialists of pediatric surgery.

Results: Bowel reduction was possible in every test, with 1 spleen rupture, 1 bowel entrapment, and 2 inappropriate sutures due to tension. Most volunteers considered the general endoscopic vision (63.2%), external and internal dimensions (both 89.5%) to be highly similar; bowel reduction (68.4%) and diaphragm's manipulation and suture (57.9%) to be highly or very highly similar. Regarding its ability to generate skills, most considered it to be very or extremely useful concerning: camera handling (52.6%), working in small spaces and suture (both 100%), and tissue handling (63.2%). The least liked features were the colors and the diaphragm's tension. The size, portability, and the reproducibility were the most liked features.

Conclusions: We consider this low cost and easily reproducible model to be realistic enough for CDH repair training, having the potential to be adapted for other simulations.

Keywords: Medical Knowledge; Practise-Based Learning and Improvement; congenital diaphragmatic hernia; neonatal surgery; pediatric thoracic surgery; resident education; surgical education; surgical simulation.