Aim: Simulation is an effective tool in enhancing surgical training where index cases are low, such as congenital diaphragmatic hernia (CDH). Our aim was to produce a simple, cheap, realistic and reusable open model of CDH as a training tool.
Method: Two models of CDH of varying defect size were designed paying attention to fidelity, ease of production and cost. Models were created using an empty glove box and non-adherent hydrocellular foam dressing simulating the abdominal wall and diaphragm. Household foam simulated liver and spleen and collagen sausage casing with jelly simulated bowel. Paediatric surgical trainees, performed full CDH repair with and without patches and were assessed by experienced trainers for tissue handling, safe delivery of organs from the chest and for suturing skills (Fig.1). Feedback was collated on fidelity of the model and learning points.
Main results: 6 paediatric surgical trainees from a single large teaching hospital participated in this exercise with varying experience (previously performed 0 to 9 cases, median =0) and supervised by 5 trainers. Feedback was obtained from all 6 trainees and 3 trainers who reported the fidelity of both the models to be very good (n=3) to excellent (n=6). The simulation session provided the opportunity for discussion and practice of various surgical techniques. Junior trainees reported learning about exposure and surgical steps and senior trainees improved suturing skills and patch techniques. Cost for each model was under £10. Both models were reusable during the session following removal of sutures.
Conclusion: We present a novel, cost effective surgical simulation model for CDH repair using simple available materials which could be easily replicated in other centres. In the future we will use this model to demonstrate progression in surgical skills.
Fig 1 - Model of a large diaphragmatic defect being repaired using a patch.