High-fidelity trainer for fetoscopic spina bifida repair

Fetoscopic spina bifida repair requires a well-trained, dedicated team to perform the surgery. However, the paucity of cases and limited training resources limit the approach's widespread adoption. Therefore, high-fidelity simulators are essential to fill these gaps.

We sought to create a synthetic, low-cost, high-fidelity simulator for appropriate training in fetoscopic spina bifida repair.

We designed a disposable, single-use, multi-layer silicone pad resembling a myelomeningocele attached to a 3D-printed fetal mannequin mounted on a positioning base. The mannequin is housed in a 3D-printed cylindrical enclosure with a removable, puncturable silicone locking lid representing the uterus. We assessed the model's realism and educational value using a 5-point Likert scale survey administered after the simulation sessions. We used the criteria proposed by Tun et al, a multidimensional tool that incorporates the patient, the healthcare facility or environment, and the clinical scenario, with specific definitions stratified by fidelity levels (low, intermediate, and high), as a reference to ascertain a trainer's fidelity.

A multidisciplinary team, comprising a maternal-fetal medicine-trained fetal surgeon, a pediatric neurosurgeon, and simulation development engineers, developed a low-cost synthetic fetoscopic spina bifida repair simulation model that enables practicing the essential neurosurgical steps of fetoscopic spina bifida repair using a three-port approach, including fetoscopic placode and fascial dissection, patch suturing to the fascial layer, and skin closure. Nine clinicians with different levels of expertise tested the final version of the trainer. Most rated the simulator's realism as "very good" or "excellent" on all surgical steps. All study participants rated the educational value as "very good" or "excellent". The model is classified as high-fidelity according to prespecified criteria.

We developed a high-fidelity, inexpensive synthetic simulator that includes all essential surgical steps for fetoscopic spina bifida repair.