Development and validation of a Dor fundoplication simulator

Our objective was to create and validate a cost-effective Dor fundoplication simulator for surgical trainees.

A scale-appropriate replica of the distal esophagus, proximal stomach, and diaphragmatic hiatus was created using felt. Ten experienced foregut surgeons evaluated it from 1 (not realistic) to 5 (highly realistic). From May 1, 2023, to November 30, 2023, 56 trainees performed Dor fundoplication before and after watching a focused teaching video, which was scored based on standard criteria. Postgraduate level 3 and under were considered Junior trainees. A median score of more than 4 (of 5) was considered the face and content validity benchmark. Construct validity was evaluated using the Wilcoxon rank-sum test.

The observed median [interquartile range] of the domains were 5 [4-5] (relevance), 5 [4-5] (ability to perform the task), 4.5 [4-5] (value), 4 [4-5] (physical attributes), 4 [4-5] (realism of experience), and 4 [4-4.25] (realism of materials) satisfying face and content validity. Seniors (n = 28) scored significantly higher on both objective and subjective measures for both video and specimen scores for both attempts (P < .001), satisfying construct validity. Trainees reported higher confidence in performing the assigned task (P < .001) on the second attempt, with seniors reporting higher confidence levels than juniors (n = 28). The overall simulation was rated as a median of 5 [4-5] by trainees.

This model satisfies all 3 benchmark criteria required to be considered validated. The global findings and comments indicate that the simulator is valuable as a Dor fundoplication teaching tool.