Simulation of cotside silo application, reduction, and sutureless closure, for gastroschisis: Performance of the...

Simulation training enhances efficacy and safety of preformed silo deployment in gastroschisis. Limitations of existing simulation models include use of biological material, low fidelity, poor durability, and high cost. We developed a novel gastroschisis simulation model and report its validation and performance in a multicentre interventional study.

Paediatric surgeons collaborated with a medical-model specialist to develop a novel GAstroschisis BaBY (GABBY)-T model. This was validated against two existing simulation models by 15 paediatric surgeons using a Likert scale (1-10) to compare each model (A,B,C) to real-life application, including tactile feedback, realism, and usefulness. Data are presented as median (range). Sixteen GABBY-T models were used to teach preformed silo use as part of a Gastroschisis Interventional Study in 37 hospitals across sub-Saharan Africa. Durability of the models was recorded.

GABBY-T model features non-biological silicone bowel, improved fidelity, and ability to simulate all aspects of preformed silo use for gastroschisis care, at $390/model. Usefulness, realism, tactile feedback (p < 0.01) and overall experience (p < 0.05) were all rated significantly higher in the new model compared to the other models (A = 9, 8, 8, 9), (B = 6, 5, 6.5, 5), (C = 6, 5.5, 5, 6), respectively. 33 % of surgeon participants would recommend older models while 100 % recommended the new model for training. During the Gastroschisis Interventional Study, each model was used >100 times. 5/16 models sustained minor bowel tears without affecting performance. Four models suffered damage requiring replacement components.

The GABBY-T model for preformed silo application simulation outperforms previous models. GABBY-T model has high fidelity and durability at moderate cost, facilitating training of large numbers of healthcare providers.