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Inanimate model to train for the thoracoscopic repair of all varieties of left congenital diaphragmatic hernia (CDH)

Epublication WebSurg.com, Jul 2018;18(07). URL: http://websurg.com/doi/vd01en5252

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  • 2018-07-18
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We present a new low-cost model designed for training skills and strategies for the thoracoscopic repair of left congenital diaphragmatic defects. We will present guidelines to make this type of models, the educational strategy that we use in our advanced training models, the defects that can be trained, and the scope of this model. Advanced training, learning tips and tricks from experts, and the use of innovative ideas from other authors used in our model are outlined. This educational tool was developed for pediatric surgeons requiring advanced training. It reinforces the concept of advanced and continuous training, in a safe environment, and it is assisted by experienced surgeons. This model shows a scenario where dimensions and anatomical repairs are carefully preserved. We share our vision of continuous endosurgical education to encourage all enthusiastic surgeons to train in safe and controlled environments. Materials and methods: The model consists in a plastic 3D printed left rib cage, extracted from a 6-month-old baby CT-scan combined with simulated mediastinal structures, diaphragm, bowel, lung, and spleen made of latex, silicone, and polyester sponge respectively. A self-adhesive film is used as parietal pleura. A removable part (spare part) represents the last three ribs where the diaphragm is partially inserted, and a base as the upper abdomen is assembled to the left rib cage (ribs 1 to 9). Abdominal viscera (plastic or animal) are placed in this base. The cost of materials is 150 US$. The model is meant to simulate the most frequent diaphragmatic defects such as type A, B, and C, with or without sac. However, other rare defects can also be simulated. Live animal tissues such as diaphragm or intestine also can be used, as it was already published by other authors. However, the main characteristic of this model is to be inanimate, portable, and easily reloadable to be reused. The video shows a junior surgeon in his advanced training process. In the model, we perform the reduction of the viscera slid to the thorax. In this case, it is the rabbit intestine, but we usually use latex simulated intestine. The spleen is completely synthetic and bleeds if the instruments damage it during the reduction. We use 3mm regular instruments. The repair of the defect is made with separate stitches of 2/0 or 3/0 braided polyester as usual, and we encourage trainees to practice the intracorporeal sliding knot and running suture. We collect the performance data in a specially prepared form and carry out the debriefing. Conclusions: With this model, we can reinforce the concept of low cost, but with a high precision environment simulation, included within a standardized training program in minimally invasive neonatal surgery. We believe that it is a very useful tool. In addition, this type of models allows the use of new surgical techniques, tips and tricks given by experienced surgeons who assist in the training process.