The Development of a Novel Laparoscopic Box-Trainer Simulation Model

Outline: In recent years, radical changes such as work hour restrictions, changing patient populations, and increasing patient safety concerns have changed the learning environment of surgical trainees (1). In paediatric surgery, there is the added factor of the rarity of certain congenital conditions which has underlined the necessity for simulation-based practice (2). What did we do? We set out to create a novel laparoscopic box-trainer model simulating an inguinal (IH) and a congenital diaphragmatic hernia (CDH). These were combined to create the Laparoscopic Inguinal & Diaphragmatic Defect (LIDD) model. We aimed to assess its construct and content validity. How did we go about it? The LIDD model was constructed from low cost materials; three pieces of ply wood joined into a triangular structure. Four equally sized holes were cut into one surface, and an elongated oval cut into the opposite surface (Figure 1A). A glove was stretched over the openings to simulate an IH orifice (Figure 1B). A piece of neoprene was placed over the larger opening to simulate a CDH (Figure 1C). We tested the model on novices (18 medical students), intermediates (85 surgical trainees) and experts (6 surgical consultants). What are the challenges and how did we overcome these? One of the main aims was to develop a low-cost model therefore we needed a low-cost ($X.00) and validated box-trainer. We overcame this by using the eoSimTM laparoscopic box trainer, which has been previously validated (Figure 2) (3). What did we find? The LIDD model showed construct validity by being able to differentiate between the three groups (P<0.05 on all comparisons). Content validity from the experts revealed a high score for both aspects of LIDD (4.8 and 4.8). There was also a high level of functional fidelity for task completion (4.0 and 4.0). Future directions - Incorporate movement tracking software with the LIDD model - Utilise in a surgical training curriculum, including home-based training - Show evidence of skill transfer to the operating room - Investigate any correlation with patient outcomes.