Desenvolvimento de modelo de treinamento para cirurgia minimamente invasiva torácica neonatal

Abstract

Thoracoscopic repair of esophageal atresia (EA) and congenital diaphragmatic hernia (CDH) is a major challenge, due to the small working space and the delicacy of the tissues involved. The simulators are an excellent tool for fellows and novice pediatric surgeons to develop essential neonatal thoracoscopy skills before acting in real cases. However, there is a gap in the prototype market, especially for training malformations such as EA and CDH. The objective of this work was to produce a fully synthetic model, with medium fidelity and low cost, for the development of EA and CDH skills. In the initial tests, tissue damage caused by simple suturing in a latex balloon, a silicone model and a silicone rubber plate (SR) were compared. Then into three types of SR: blue, green and white. To compose the external framework, a plastic doll was used, with the facies of a 3 kg baby. The internal thoracic framework was composed of the thoracic spine, internal costal framework, aorta, vena cava and trachea, formed from corrugated conduits and colored cylindrical balloons. Twelve “entrance ports” were made in the left hemithorax of the simulator. For the acquisition of images and internal lighting, a cylindrical microcamera of 4 mm in diameter was used, with image transmission to cell phones and notebooks. In the last stage of tests, three groups of surgeons were evaluated in terms of time and according to a scale of skills (OSATS) in performing a task. In addition to answering a Likert-type form about the model tried. In the initial testing phase, it was demonstrated that SR had a better result than silicone and there was no difference between the types of SR. For the esophageal model, a rectangular SR plate was bent along its longest axis and, for the artificial diaphragm, a 2x1 cm defect was produced. In the third stage of tests, fellows in pediatric surgery had a longer time and a lower OSATS index, close to pediatric surgeons with an intermediate level. Experienced surgeons had lower time and higher OSATS index than the others. The Likert scale responses showed the excellent acceptance of the proposed models. A fully synthetic, medium-fidelity, financially accessible model was developed that allows the training of fellows and pediatric surgeons in the surgical treatment of EA and CDH.