Innovative Simulation Model for Enhancing Training in Fetoscopic Spina Bifida Repair
Claudio V Schenone1, Sofia Musi1,2, Farokh R Demehri3
1Division of Fetal Medicine and Surgery, Fetal Care and Surgery Center (FCSC), Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Objective:
To explore our simulation model's ability to ascertain changes in surgical performance in practitioners with varying levels of expertise.
Methods:
A fetal surgeon, a fetal surgery fellow, and a medical student performed fetoscopic spina bifida repairs using our simulator. During each session, we assessed fetoscopic skills using a Global Rating Scale (GRS) (minimum and maximum score was 9 and 45, respectively), time to completion, and watertightness of the closure. A mixed linear model assessed the influence of expertise level and session number on GRS scores and operation time. We evaluated the frequency of water tightness, defined as no leakage at the suture line after injecting a pre-specified water volume beneath the repaired layer. A generalized linear mixed model assessed changes in the likelihood of achieving a watertight closure over time and according to expertise level.
Results:
Each participant completed 10 simulation sessions. Expertise level influenced the GRS scores (F = 20.10, p = 0.04). Operation time decreased over time (F = 30.6, p = < 0.001). Optimal watertight closure was achieved in 60% of cases by the fetal surgeon and 30% of cases by the fetal surgery fellow and medical student. There was a non-significant increase in odds of achieving watertight closure with each session (odds ratio 1.27, p = 0.12).
Conclusions:
Our fetoscopic spina bifida repair simulator demonstrated changes and may enhance surgical performance across varying expertise levels. However, larger studies are needed to validate our findings.
