Design and validation of a low-cost modular simulator for training in neonatal laparotomy and jejunoileal atresia repair

PURPOSE: Surgical treatment of neonatal jejunoileal atresia requires highly specialized skills, but its rarity makes training opportunities sparse. We aimed to address this by developing and evaluating a low-cost, high-fidelity, modular simulator for comprehensive training in neonatal laparotomy and small bowel atresia repair. METHODS: Our design consisted of three primary components: bowel, abdominal wall, and abdominal cavity. 3D-printed molds were used to cast silicone models of type II and type IIIa atretic bowel with its mesentery. The abdominal wall was created by layering molded silicone and fabric. A small 3D-printed enclosure with an opening and bony landmarks was designed to simulate the neonatal abdomen. The material cost per model was ∼$16.88 USD, with each subsequent use costing ∼$5.09 USD. Eight expert surgeons and eight surgical trainees performed simulated atresia repairs and stoma creations. Participants rated face and content validity on a 5-point Likert scale. Videos of the simulated procedures were evaluated by an attending pediatric surgeon to assess construct validity by comparing performance between experts and trainees. RESULTS: The highest mean realism ratings were for surface anatomy (4.06) and anatomical structure (4.06). Content validity responses were positive (mean ratings >4), indicating that participants found the model thorough and valuable. Trainees made significantly more mistakes (p = 0.001) and completed fewer tasks (p = 0.01) than experts. CONCLUSION: Our simulator demonstrated strong face, content, and construct validity. It offers an accessible, cost-effective training tool, with promise for implementation in both high- and low-resource settings with limited surgical training opportunities.