Portable Neonatal Esophageal Atresia Simulator Improves MIS Acquisition Amongst Surgical Trainees: A Randomized Control Crossover Trial.

Abstract

Background: Minimally invasive surgical (MIS) skills are increasingly expected of surgical trainees; however, opportunities to practice these outside the operating theater are limited. Current pediatric surgery trainees have limited exposure to thoracoscopic repair of esophageal atresia (OA/TOF) during their training. We evaluated the utility of a neonatal OA/TOF simulator for the acquisition and retention of MIS skills amongst surgical trainees.

Methods: Randomized controlled cross-over trial of 20 surgical trainees in New Zealand. Participants were block-randomized into two groups: SIM versus NO-SIM groups. Each group had 12 weeks of access to the take-home Symulus neonatal OA/TOF simulator before crossover. During the intervention period, participants practiced three MIS tasks in a self-directed manner: ring transfer (RT), needle pass (NP), and anastomotic suture (AS). Modified objective structured assessment of technical skills (OSATS) scores were recorded at baseline, mid-point, and study completion.

Results: OSATS scores were highest for the RT task, followed by NP and AS tasks. A significant increase in OSATS scores was observed for the NP (P = .017) and AS tasks (P < .001). The SIM group, who had earlier access to the simulator, appeared to outperform the NO-SIM group at all time points, although this difference did not reach statistical significance. While the RT and NP scores converged over time, the AS scores (representing a higher level of skill) diverged over time.

Conclusions: Our analysis demonstrates the effectiveness of this OA/TOF simulator in facilitating the acquisition and retention of MIS skills via self-directed learning. These findings support the integration of similar surgical simulators into current training programs to enhance MIS skill acquisition in a low-risk, accessible setting; particularly for those procedures where the complexity is high, but the frequency of cases is low.