Inguinal Hernia Surgical Simulator

A 3D-printed Pediatric Open and Laparoscopic Integrated Simulator for Inguinal Hernia Repair (POLISHeR)

Partner

Munich Team

The Digital Lab

Type of work

technology
3D Printing
Advanced Simulation
Overview

Inguinal Hernias Require Surgical Care

Inguinal hernias appear as a bulge in a patient’s groin region and occur when tissues from the abdomen push through weakened abdominal muscles. As these hernias are common throughout childhood, inguinal hernia repair (IHR) is a key pediatric surgical procedure. The success of this surgery is heavily reliant on the knowledge of a patient's groin anatomy, and both open, and laparoscopic approaches require considerable repetition to master. As surgical simulations have shown promise in other surgical fields, the Munich Team and the Digital Lab came together to develop a 3D printed open and laparoscopic pediatric IHR simulator.

Research & Design

Creating a 3D Printed Surgical Simulator

To develop a model that was optimal for IHR practice, the team opted to create a virtual 3D model  of a 2-year-old child. The structures that were segmented in the creation of the model were determined based on findings from normal contrast-enhanced computed tomography (CT) scans of both male and female patients aged 3-7. To limit the impacts of small patient size and radiation treatment on anatomical accuracy, a CT scan of a 7-year old patient was scaled to model the 2-year old following validated protocols. After being validated by a radiologist the model was manufactured.

Combinations of silicone, mesh, and thread were utilized to create low-cost skin, the aponeurosis of the external oblique, preperitoneal fat, cremaster muscle, retroperitoneum, and peritoneum. Other anatomical structures such as ligaments and blood vessels were constructed from rubber, rope and thread. A condom was used to replicate the hernia sac.  

Using Computer Aided Design (CAD) software, a physical simulator was designed to encapsulate all 3D printed anatomical structures and to include modular sections for laparoscopic and open inguinal hernia repair cartridges. Through an iterative design process, all additive manufactured components were incorporated into the cartridge designs with detailed instructions on replacing and assembling the cartridges for both surgical techniques.

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Impact

Ongoing Evaluation with Surgical Experts

Validation of our bespoke Inguinal hernia surgical simulator is currently ongoing and being completed by surgical residents, fellows and experienced surgeons to participate who have been invited to participate in iterative qualitative user testing. Participants will engage in simulated scenarios where they will perform both open and laparoscopic surgeries on our simulator, adhering to procedural surgical steps and related anatomical landmarks, before completing a post-simulation questionnaire. The goal of the questionnaire is to assess anatomy representation, instrument handling, procedural content, perceived realism, confidence and comfort level. With expert feedback, and continued iteration the team aims to expand the use of this surgical training tool to optimize IHR education and treatment.

Learn More

Selected as top 10 abstract to present at the Canadian Association of Pediatric Surgeons 2024