Development of a 3d-printed neonatal congenital diaphragmatic hernia model and standardisation of intra-operative measurement

Introduction: three-dimensional (3D) printing is frequently used for surgical simulation and training however no widely available model exists for neonatal congenital diaphragmatic hernia (CDH). The aim of this study was to develop a 3d-printed model of CDH and test interobserver variability in the simulated model for obtaining measurements of the diaphragmatic defect and ipsilateral diaphragm.

Methods: a term fetal MRI (3.5kg) of thorax, diaphragm and defect (15mmx15mm) were delineated and segmented after parental consent to produce 3d-printed models. Consultant and trainee paediatric surgeons were invited to measure the posterior-lateral diaphragmatic defect and ipsilateral diaphragm. Mean measurement error was calculated (millimetres). Data are presented as median (range) and number/total (%).

Results: an abdominal and thoracoscopic model were produced and tested by 52 participants (20 consultants and 32 trainees). Diaphragmatic defect via laparotomy measured 15 (10-20)mm (AP) x 16 (10-25)mm (ML) and thoracoscopically 14 (11-19)mm (AP) x 15 (11-22) mm (ML). Mean error per measurement was 4 (1-17)mm via laparotomy vs. 3 (0.5-9.5)mm thoracoscopically. Mean error was similar between consultants and trainees via laparotomy (4.3 vs 3.9mm, p=0.70) and thoracoscopically (3 vs 3mm, p=0.79). Error did not correlate with experience as operating surgeon via laparotomy (β=13.0[95% CI -55.9 to 82.0], p=0.71) or thoracoscopically (β=1.4[95% CI -6.4 to 9.2], p=0.73.

Conclusions: we have designed and built simulation models for CDH repair via laparotomy and thoracoscopically. Operators can reliably measure the diaphragmatic defect and ipsilateral diaphragm, regardless of surgical experience and operative approach.

0179-0358

Bethell, George S.

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Eastwood, Mary Patrice

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Neville, Jonathan

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Harwood, Rachel

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Bethell, George S.

c7a62cc1-5573-41f6-ae00-3c11e8219dd4

Eastwood, Mary Patrice

de49bd37-a57c-4037-a2ef-02a0b05df99b

Neville, Jonathan

d6f42f0e-48a8-43ac-bb05-0f6692cf8a14

Harwood, Rachel

3796311f-d3cf-4f68-bdd6-08bdae92998f

Bethell, George S., Eastwood, Mary Patrice, Neville, Jonathan and Harwood, Rachel (2023) Development of a 3d-printed neonatal congenital diaphragmatic hernia model and standardisation of intra-operative measurement. Pediatric Surgery International. (In Press)

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Accepted/In Press date: 13 November 2023

Additional Information: Paediatric Surgical Trainees Research Network (PSTRN) and SurgeryLabs PSTRN Writing Group George S Bethell (University Surgery Unit, University of Southampton, Southampton, UK), Mary Patrice Eastwood (Department of Paediatric Surgery, Royal Belfast Hospital for Sick Children, Belfast, UK) Jonathan Neville (University Surgery Unit, University of Southampton, Southampton, UK) and Rachel Harwood (Department of Paediatric Surgery, Alder Hey Children’s Hospital, Liverpool). ‘The Defect Study’ Lead Team Mary Patrice Eastwood (Department of Paediatric Surgery, Royal Belfast Hospital for Sick Children, Belfast, UK), George S Bethell (University Surgery Unit, University of Southampton, Southampton, UK), Sajeed Ali (Department of General Surgery, Northwick Park Hospital, London, UK), Setthasorn Zhi Yang Ooi (Cardiff University School of Medicine, Cardiff, UK), Joshua Brown, Lucinda Tullie (Specialist Neonatal and Paediatric Surgery, Great Ormond Street Hospital NHS Foundation Trust, London, UK), Sesi Hotonu (Department of Paediatric Surgery, Edinburgh Royal Infirmary, Edinburgh, UK), Rachel Harwood (Department of Paediatric Surgery, Alder Hey Children’s Hospital, Liverpool, UK), Timothy J. Bradnock (Paediatric Surgery, Royal Hospital for Children, Glasgow, UK) and Nigel J Hall (University Surgery Unit, University of Southampton, Southampton, UK). SurgeryLabs Sofia Chacon (Department of Paediatric Surgery, Chelsea and Westminster Hospital, London, UK), Reza Haghighi Osgouei and Jonathan Neville (University Surgery Unit, University of Southampton, Southampton, UK).