Simulations Help Transform Novice Surgeons Into Experts

sim lab
Two young pediatric surgeons are in an operating room performing a minimally invasive procedure on a newborn to repair a diaphragmatic hernia—a congenital anomaly resulting in an abnormal opening in the muscle the baby uses to breathe. The opening has also caused some of the baby’s internal organs to push up into his chest cavity, complicating the surgery.
 
The surgeons are working in the child’s chest within a space about the size of an egg. After 35 minutes, they finish the operation and suture closed the three tiny incisions.
 
Instead of being taken immediately to a recovery room where his parents are anxiously waiting, the baby remains on the operating table as Katherine Barsness, MD, an attending physician specializing in minimally invasive surgery at Lurie Children’s, joins the two surgical fellows for a post-operative discussion.
 
An Incredibly Realistic Model
The “baby” is still on the table because the surgeons were participating in an incredibly realistic neonatal surgery training simulation developed by Dr. Barsness. The procedure uses a model containing biological animal tissue to simulate the anatomy a surgeon would encounter in a real procedure. They are working in the simulated operation room at nearby Northwestern University Feinberg School of Medicine’s Northwestern Center for Advanced Surgical Education (NCASE), which is outfitted with some of the most advanced surgical technology available.
 
“Whenever new surgical procedures are introduced, there’s a learning curve,” says Dr. Barsness. “But that learning curve belongs in the simulation lab, not in the operating room. When learning a procedure, surgeons are often ranked according to the level of their baseline skills as ‘novice,’ ‘capable,’ ‘proficient’ and ‘expert.’ But if you ask any patient’s family whether they’d like a ‘capable’ or an ‘expert’ level surgeon to operate on their child, which one do you think they’re going to choose? Our goal is to use simulations to train all surgeons to be ‘experts’ in these procedures, some of which they may perform only a few times a year.”
 
Meet the Sims
Since 2011, Dr. Barsness has collaborated with biomedical engineers and architectural designers at Northwestern University to develop five neonatal training models. In addition to simulating the repair of a diaphragmatic hernia, other models simulate tracheoesophageal fistula, duodenal atresia repair, a lobectomy procedure and gastrostomy tube placement.
 
The models were created in Northwestern’s Innovations Lab using molds created on 3D printers. Each model has variants that differ in how closely they replicate a surgical procedure. Low-fidelity models are used as “task trainers” for those with limited experience in performing a specific skill. Middle-fidelity models are used to represent a series of tasks within a single operation, and replicate human tissue and anatomy using synthetic materials. High-fidelity models may incorporate real animal tissue that can be configured to present trainees with the entire procedure, including potential complications.
 
Creating the “Ultimate Simulator”
Dr. Barsness also developing a complete operating room simulator that would involve anesthesiologists and surgeons working together. She calls it the “ultimate simulator.”
 
“This simulator would not only address any individual technical and knowledge gaps, but any performance gaps as a team,” she says. “It could simulate all the adverse events that might happen during an operation, and train the surgeons and anesthesiologists to work together to correctly identify a problem, respond to it and recover from it to prevent harm to the patient. With this simulator, we could make a near-immediate impact on patient care, which will also translate into cost savings. Operations will be more efficient and safer, with fewer complications and shorter hospital stays.”
 
Over the last two years, Dr. Barsness has trained more than 150 surgeons around the world in these advanced procedures using her models.
 
This article originally appeared in the Fall 2013 issue of Heroes magazine.