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The traditional trajectory of surgical learning follows the “see one, do one, teach one,” paradigm. Under that model, novice surgeons learn by observing, assisting with and eventually performing operations of increasing complexity under the supervision of senior surgeons. Yet, even with close supervision and watchful guidance, the risk for patient harm remains real when the surgeon performing the repair is still in the learning phase.
In addition, certain conditions are so complex and so rare that mastering a repair technique can take years. Some congenital anomalies, for example, are encountered so infrequently that many pediatric surgeons don’t have an opportunity to observe, participate and perform one, let alone become experts in treating it.
Simulation training can help take the risk for patient harm out of the equation. It can also provide surgical training models of complex and rare conditions so that new surgeons can try their hands repeatedly at repairing them.
Lurie Children’s Surgical Simulation Training Program, led by Katherine Barsness, MD, MS, is dedicated to helping pediatric surgeons cross over from “good” into “great” territory.
3-D Printed Models of Rare Surgical Disease
Simulation training occurs at the intersection of surgery, biomedical engineering and architectural design. It is based on realistic 3-D models that mimic the intricate structure of infants’ and children’s organs.
Current 3-D disease models used for training include:
Esophageal atresia - a rare congenital malformation that occurs when the esophagus — the passageway that carries food from the mouth into the stomach — fails to connect to the stomach.
Tracheo-esophageal fistula - a birth defect in which the esophagus is abnormally fused with the trachea (windpipe) instead of connecting with the stomach.
Congenital diaphragmatic hernia, marked by an abnormal “hole” in the muscle that separates the chest from the stomach. The abnormal opening allows abdominal organs including the intestines and liver to move up into the chest and put dangerous pressure on the lungs.
Duodenal atresia - a birth defect in which the uppermost part of the intestine, the duodenum, does not connect with the rest of the intestinal tract.
Congenital pulmonary adenomatid malformations (CPAM) - a malformation of the lungs that involves several anatomic anomalies that impede the lungs’ normal function, making children with the condition more prone to pneumonia and other pulmonary diseases.
3-D printed airway models are also used to teach surgeons how to perform airway foreign body removal, a procedure used to access the lungs and remove inhaled food particles or foreign objects.
Surgeons-in-training can also use 3-D sim stomach models to perfect their skills in placing gastric (feeding) tubes — often needed as a temporary solution for children who cannot eat normally.
3-D models of congenitally malformed hearts are currently in development.
There is mounting evidence that simulation-based training can boost performance and improve objective measures of technical skills, shorten operative times, and minimize patient harm and adverse outcomes. Dr. Barsness is currently leading a multi-center study to evaluate the impact of adding her 3-D models to traditional surgical training programs.
Access and availability of skilled surgical care is an acute problem in certain regions of the world where the infrastructure and resources to cultivate surgical talent are lacking. As a result, many infants and children suffer permanent disability or death from treatable conditions.
In addition to traveling to underdeveloped countries to train surgeons and bringing surgeons from these regions to Chicago for training, Barsness is currently developing a program that would establish regional simulation training centers across the globe.
In the last several years, more than 350 surgeons from across the country and all over the world have trained using the Barsness approach.