Last week at the Boston Children’s Hospital Global Pediatric Summit, the hospital’s pediatric simulator program (SIMPeds) displayed two uncanny additions to its family of surgical trainers.
These simulators are not your typical Resusci Anne mannequins. BCH enlisted the help of Emmy winning special effects company Fractured FX to make the models as visually and haptically correct as possible. “Prior to this trainer we basically had tubes that ran through a block of silicone,” explains Melissa Burke, Director of Operations at SIMPeds. “It didn’t feel right at all.”
That is not the case with the new, ultra-real simulators, the visual and tactual details of which are unprecedentedly accurate. These simulators consist of 3D printed components, gels, and, in the case of soft materials that simulate tissues, components cast from 3D printed molds. Additionally, the simulators include a pump system to create the kind of pulsation one would experience while operating on a live patient.
Each model helps simulate a rare, high-risk surgical event for which surgeons lack rehearsal opportunities. The first model, which replicates the neck and upper chest of an infant, allows surgeons to simulate putting a child on ECMO, a form of partial cardiopulmonary bypass. The second model, which replicates an adolescent male’s skull and brain, helps neurosurgeons practice an endoscopic third ventriculostomy (ETV), used to treat hydrocephalus.
To make the models look and feel as authentic as possible, SIMPeds and Fractured FX consulted extensively with surgeons, even videotaping them using the prototypes so that they could incorporate feedback into more accurate iterations.
Rehearsing an ECMO or ETV procedure on these models helps avoid surgical complications. In the case of the ETV procedure, for example, the surgeon must poke a hole in the base of the third ventricle to give intracranial fluid an additional pathway to drain. This procedure is particularly risky, given the ventricle’s proximity to the basilar artery. “You only get one shot at creating this hole,” says Burke, stressing the importance of accuracy.
“The material that we’ve developed feels right as the endoscope passes through,” continues Burke. “You feel a little pop as you enter the ventricular cavity, you see all of the landmarks exactly as they would appear in a live patient, and then as you approach the floor of that third ventricle, you see the pulsation that you would in that membrane.”
In addition to helping familiarize surgeons with surgical procedures, the models also create rehearsal situations for clinical teams providing a way for the team to mature its communication style and techniques. Fifty percent of medical errors result from miscommunication among medical professionals.
This is not the first time that SIMPeds, founded 12 years ago by Dr. Peter Weinstock, has pioneered patient simulation.
Two years ago, engineers at SIMPeds began 3D printing models of patient anatomy, based on individual MRI or CT scans, for surgical pre-planning. Unlike the newest simulators, which represent a generic surgical situation for a generic child, these models allow surgeons to plan complex surgical procedures on exact replicas of a specific patient’s anatomy before ever stepping foot into the OR. In the case of Violet Pietrok, a child born with a rare craniofacial defect, SIMPeds provided Violet’s doctor with 3D printed replicas of her skull on which he might plan corrective surgery.
In the future, the SIMPed program will likely continue using 3D printing to develop individual-specific and generic models that allow surgeons to rehearse a variety of procedures. “What we’ve created through this partnership with Fractured FX is a knowledge transfer to the engineers here at BCH where we can now create any type of haptically correct, and even ultrasoundable, trainer for the purposes of training staff here,” says Burke. “There is a very long list of potential work that we could do.” Although unable to give specifics about future generic trainers in development, potential work in the field of pediatric urology is likely.
BCH hopes to sell the ECMO trainer commercially at an estimated cost of $5,000 to $10,000 per trainer, according to Burke. Hospitals will be able to purchase kits with components to replace those that were cut or damaged during the simulated procedures, so the trainers can be reused.
The SIMPeds program has organically become an important facet of the innovation ecosystem at BCH.
Specifically, physicians familiar with the engineering and prototyping capabilities of the SIMPed program have approached the team to help engineer and rapid prototype medical devices. One such group wished to create a small device that would clean the port in an IV unit to reduce infection. “They had an engineer and a design, but they had no way to create the components,” explains Burke. “We printed over a hundred components for them, and became an important part of their initial prototyping.”
Burke and the SIMPeds team hope to continue to accelerate innovation at BCH. In February of next year, BCH plans to open of a 3,500 square foot “inventor space” which will house 3D printers, machine shop equipment for rapid prototyping and areas dedicated to special effects, virtual and augmented reality and social robotics.
“We are, as a simulator program, able to use our expertise to be a very important part of the innovation that occurs at the hospital.”
Abby Ballou is the managing editor of MedTech Boston. She has a B.A. and M.Phil in English literature from NYU and the CUNY Graduate Center, respectively. When she isn't writing and editing for MedTech Boston, Abby enjoys reading, rock climbing, watching classic movies and listening to opera.
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