Christchurch surgeons have harnessed high technology and Kiwi ingenuity to come up with a solution to teaching a rare life-saving surgical procedure to the next generation of doctors.
Paediatric surgeon Spencer Beasley literally wrote the book on oesophageal atresia – a condition in which a newborn’s oesophagus (or gullet) doesn’t connect to the stomach.
A common complication of the condition is that the windpipe is connected to the stomach instead, forcing acid into the baby’s lungs. Premature babies are more likely to be affected. Babies do not survive without delicate corrective surgery.
“We perform this challenging and unforgiving surgery on tiny babies usually within a day of their birth,” Beasley says. “The stakes are extremely high. You have to get it right the first time. If it’s done inexpertly, the child faces many more operations.”
Beasley has been doing the surgery for more than 30 years. In the 1990s he published the definitive book on the condition, which is now used globally. But while he and fellow consultant surgeons such as Jon Wells are experts, teaching the next generation poses a real problem. “It’s hard for our trainees because at present the only way they can learn is on actual cases. Because it only occurs in about one in 4000 births – or about four cases in the South Island each year – the big question is: ‘How do we best train the next generation of paediatric surgeons to do such a difficult and uncommon procedure?’”
In early 2017, Spencer and Wells put their heads together to dream up the ideal simulator… together they created a simulator using 3D-printed plastic for the ribcage cavity, and silicone moulds of the oesophagus and trachea.
The answer: a home-grown simulator. Teaching hospitals in the United States and Britain have created simulators, but with limitations. They use tissue from rabbits or piglets to mimic the oesophagus which brings with it ethical considerations, increased costs, and lengthy consent processes.
In early 2017, Spencer and Wells put their heads together to dream up the ideal simulator.
They applied some number eight wire mentality and then Wells, who has been co-ordinating the research, contacted the Canterbury District Health Board’s department of medical physics and bioengineering. Together they created a simulator using 3D-printed plastic for the ribcage cavity, and silicone moulds of the oesophagus and trachea.
Using 3D-printing means they can make things exactly the right size, giving a precise, accurate model of a premature baby. Simulator parts can be produced cheaply. The entire machine fits in a box and potentially could be shipped to hospitals around the world, including to developing countries – with none of the ethical issues or logistical challenges of other models.
University of Otago medical student David Nairn is researching the simulator to make sure trainees who use it get the necessary technical skills, and that this acquisition of technical expertise can be measured.
The next step is taking it to a medical conference of the world’s leading paediatric surgeons to study them using it and validate the model. The team are also exploring commercial and copyright issues. “We’re really proud of this simulator and the diverse team of people who have contributed to its development,” Beasley says. “We think it’s got real potential to prepare the next generation of paediatric surgeons to learn how to do this life-saving surgery safely and expertly.”
“It’s hard for our trainees because at present the only way they can learn is on actual cases. The stakes are extremely high. You have to get it right the first time.”