Design and validation of a low-cost modular simulator for training in neonatal laparotomy and jejunoileal atresia...

Surgical treatment of neonatal jejunoileal atresia requires highly specialized skills, but its rarity makes training opportunities sparse. We aimed to address this by developing and evaluating a low-cost, high-fidelity, modular simulator for comprehensive training in neonatal laparotomy and small bowel atresia repair.

Our design consisted of three primary components: bowel, abdominal wall, and abdominal cavity. 3D-printed molds were used to cast silicone models of type II and type IIIa atretic bowel with its mesentery. The abdominal wall was created by layering molded silicone and fabric. A small 3D-printed enclosure with an opening and bony landmarks was designed to simulate the neonatal abdomen. The material cost per model was ∼$16.88 USD, with each subsequent use costing ∼$5.09 USD. Eight expert surgeons and eight surgical trainees performed simulated atresia repairs and stoma creations. Participants rated face and content validity on a 5-point Likert scale. Videos of the simulated procedures were evaluated by an attending pediatric surgeon to assess construct validity by comparing performance between experts and trainees.

The highest mean realism ratings were for surface anatomy (4.06) and anatomical structure (4.06). Content validity responses were positive (mean ratings >4), indicating that participants found the model thorough and valuable. Trainees made significantly more mistakes (p = 0.001) and completed fewer tasks (p = 0.01) than experts.

Our simulator demonstrated strong face, content, and construct validity. It offers an accessible, cost-effective training tool, with promise for implementation in both high- and low-resource settings with limited surgical training opportunities.