Surgeons practice complex procedures on 3D models

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How does a doctor get better at their craft? Simulating real surgical situations but not with human patients.

“Some of the operations that we are called on to do we may only do once a year. But just because they’re rare, that suggests that we don’t have enough opportunities to make sure we’re at the top of our game,” said Dr. Katherine Barsness, Director of Simulated Surgery, Lurie Children’s Hospital.

This is not medical school. It’s the Surgical Simulation Center at Northwestern Medicine, and it’s where all levels–from young fellows to experienced physicians–come to sharpen their skills.

“Simulation-based education is very, very new in medical education overall.  So during my training, we didn’t really do anything in the simulation lab. We learned by what’s called the classical Halstedian model, which is see one, do one, teach one.” Barsness said.

That’s not the model here. Here, surgeons practice rare and tricky minimally invasive procedures long before they treat their actual patients.

“So right now I’m working on a congenital diaphragmatic hernia, which is a hole in the diaphragm of a baby.  And that hole allows the intestines to protrude from the abdomen into the chest. And so the operation that we’ve simulated here today is that I’ve pushed the intestine back down into the abdomen and now I’m closing the hole in the diaphragm,” said Dr Timothy Lautz,  pediatric surgery fellow.

At another table, Loyola pediatric surgeon Dr. Alexander Dzakovic came to practice a complex trachea operation.

“So this is a model for a tracheoesophageal fistula, which is basically a disconnect of the food pipe in a newborn. And the downstream part is connected to the vent pipe.  So there’s challenges for anesthesia, this poses challenges for the surgeon–we have to make the two ends meet, literally. Things are very small, tissues are very delicate, which is why it’s very helpful to have models where we can practice and be prepared for the operating room,” Dzakovic said.

“It does take deliberate practice, and it takes hours or hundreds of hours to achieve those kinds of results,” Barsness said.

 The Sim Lab is Lurie Children’s surgeon Katherine Barsness’ baby–right down to the baby-sized rib cages created in the lab’s innovation center.

“And the minute I saw that tiny little rib cage, I immediately thought of neonatal surgery. And I thought how can I possibly use that rib cage, to translate over to what I teach every single day?” Barsness said.

 Dr. Barsness merged the tiny models with bovine tissue that looks and feels human.

“It’s very real.  So the muscle is real muscle, but we also have the constraints of a rib cage, which is created using the 3D printer. So this hybrid model gives you the best of both worlds,” Barsness said.

 And it’s making a world of difference for patients and their parents.

“Parents will often ask any surgeon, ‘How many times have you done this operation?’ And traditionally we only counted the number of times we did it in a real baby. But now you are able to overcome the technical challenges of the operation on a model and not on a human,” Lautz said.

 “No child deserves to have complications due to a physician’s learning curve. We would rather take that learning curve and put those complications in the lab, where we can safely teach, and move beyond those complications, ” Barsness said.

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