Iterative Design and Manufacturing of a 3D-Printed Pediatric Open and Laparoscopic Integrated Simulator for Hernia Repair (POLISHeR).

Abstract

Background: Inguinal hernia is a common childhood pathology, making inguinal hernia repair (IHR) a key pediatric surgical procedure. Surgical success relies heavily on knowledge of groin anatomy, and both open and laparoscopic approaches require considerable repetition to master. As surgical simulators have been shown to improve performance for other surgical procedures, we developed a combined open and laparoscopic pediatric IHR simulator-named POLISHeR-to train residents, fellows, and practicing surgeons in both types of repair.

Methods: A CT scan of a 7-year-old was scaled down to create a virtual 3D model of a 2-year-old using our validated protocol for anatomical modelling. Physical replicas of the pelvis, abdominal wall, aorta, and inferior vena cava were 3D-printed to create a life-size unisex base for open and laparoscopic IHR, while a small mobile unisex base was 3D-printed for open IHR. We recruited six experienced surgeons and trainees to pilot the face validity of POLISHeR.

Results: After multiple iterations, we successfully developed a modular 3D-printed simulator for open and laparoscopic IHR. Printing the life-size base cost $331.69 USD, whereas the small base cost $17.54. An open modular cartridge cost $9.92 for females and $14.21 for males, whereas replacement parts cost under $1.30. A laparoscopic modular cartridge cost $6.16 for females and $10.91 for males, whereas replacement parts cost $0.28. Pilot study participants provided encouraging feedback with respect to POLISHER's face validity.

Conclusions: Our low-cost simulator holds promise for enhancing training for pediatric IHR. Our next step is to conduct validation trials for trainees and practicing surgeons in both well-resourced and resource-limited settings.

Level of evidence: Not applicable.