C. A. Ostertag-Hill1, M. Silver2, G. J. Loan2, S. Wilson2, B. H. Dickie1 1Children’s Hospital Boston, Surgery, Boston, MA, USA 2Children’s Hospital Boston, Simulator Program (SIMPeds), Boston, MA, USA
Introduction:
Simulation in surgical training has come to the forefront for teaching technical skills in a safe, controlled environment. Pediatric surgery frequently involves the management of rare congenital anomalies that may require complex, technical maneuvers that can be reproducible via simulation. Anorectal malformations (ARM) are rare congenital anomalies. The average number of ARM repairs performed by U.S. pediatric surgery trainees graduating in 2016 was 15.5 with recertifying American pediatric surgeons performing an average of only 2.2 ARM repairs annually. Our aim was to develop a high-fidelity ARM surgical model that allows for simulation of operative steps of the reconstruction.
Methods:
A team composed of a pediatric colorectal surgeon and Simulation Program engineers collaborated to clarify the needs of the instructor, desired features, and characteristics of the simulator. Anatomic imaging and surgical video reference were used to develop the design using digital modeling software packages (Materialise 3-Matic, Pixologic ZBrush). A prototype was fabricated using a combination of 3D-printing, hand-sculpting, and multi-stage silicone injection molding techniques. Feedback on the appearance and haptics of critical anatomic structures and overall user experience was incorporated into a subsequent iteration of the design using digital design software (3D Systems Geomagic Freeform, Dassault Systemes SolidWorks). Further, the design incorporated improvements to the manufacturing process and tooling design to achieve improved reproducibility and a lower labor burden. The model development was based on steps of the procedure that was verified using a Delphi model.
Results:
Prototypes were evaluated and refined iteratively to achieve satisfactory performance of the simulator. The steps of a posterior sagittal anorectoplasty (PSARP) were successfully performed on this model by a pediatric colorectal expert and subsequently by trainees.
Conclusion:
High-fidelity synthetic anatomic models offer the opportunity to learn and practice the steps of rare and complex surgical procedures. Future research will focus on validating this simulator’s ability to replicate a PSARP and assess its potential role in training, assessment, and maintenance of skills.
