Validation of a Low-Cost Do-It-Yourself Model for Neonatal Thoracoscopic Congenital Diaphragmatic Hernia Repair

We aimed to develop and validate a low cost, do-it-yourself model for neonatal thoracoscopic congenital diaphragmatic hernia (CDH).

Volunteers with varying skills in neonatal minimally invasive surgery tested and evaluated the model simulating a neonatal thoracoscopic CDH repair. The model was built from ordinary materials purchased in a dime store: a small food container, a neoprene band simulating a diaphragm, an inflated balloon simulating a spleen, a tissue chord simulating intestine, and a body wash sponge simulating a collapsed lung. The evaluation comprised 3 sets of 5-point grading scale concerning appearance, necessary maneuvers, and ability to generate skills. Bowel reduction and suture efficacy was verified for each test.

Minimally invasive surgery simulation room at Pediatric Surgery Department of Hospital Universitario de Vall d'Hebron, Barcelona, Spain.

Volunteer residents and specialists of pediatric surgery.

Bowel reduction was possible in every test, with 1 spleen rupture, 1 bowel entrapment, and 2 inappropriate sutures due to tension. Most volunteers considered the general endoscopic vision (63.2%), external and internal dimensions (both 89.5%) to be highly similar; bowel reduction (68.4%) and diaphragm's manipulation and suture (57.9%) to be highly or very highly similar. Regarding its ability to generate skills, most considered it to be very or extremely useful concerning: camera handling (52.6%), working in small spaces and suture (both 100%), and tissue handling (63.2%). The least liked features were the colors and the diaphragm's tension. The size, portability, and the reproducibility were the most liked features.

We consider this low cost and easily reproducible model to be realistic enough for CDH repair training, having the potential to be adapted for other simulations.