“If any one of us was missing, the simulator just wouldn’t have come to fruition.”
The Symulus surgical simulator was designed for surgeons by surgeons, but it doesn’t end there. It is the unique culmination of tremendous experience, diverse expertise, commitment and scientifically-robust process. This is the story of how two eminent paediatric surgeons, a surgical registrar, a plastics engineer, and a medical physicist joined forces to create a high-fidelity simulator, set to train the next generation of paediatric surgeons in life-saving surgery.
Innovative Beginnings
When leading paediatric surgeon and Clinical Senior Lecturer at University of Otago Dr.Jonathan Wells was in surgical training, he was taught an open procedure to repair Oesophageal Atresia and Tracheo-Oesophageal Fistula (OA/TOF). While effective, it is relatively invasive for the infant. Minimal access solutions are potentially better, but training for the already-challenging operation is hard enough, let alone making it minimally-invasive.
Jon’s passion for advancing simulation-based education through research—currently laying the groundwork for surgical trainees as part of the team at the University of Canterbury Simulation Centre—led him to an innovative idea. Having seen how 3-D printing technology was becoming more advanced and affordable, Jon was inspired to harness it to design a simulator that would shift training from the risk and stress of the operating theatre to safer, more confidence-inspiring environments like at home or the simulation lab.
World-leading expertise
Enter Prof. Spencer Beasley, a global expert on oesophageal atresia, who joined Jon to develop the model for the simulator. Spencer has been performing this surgery for over three decades and is a luminary in the field—having published extensively and written the authoritative book on OA/TOF used across the world. Spencer is Professor of Paediatric Surgery at University of Otago, the Clinical Director of the Department of Paediatric Surgery at Christchurch Hospital, and former President of the New Zealand Society of Paediatric Surgeons, Pacific Association of Paediatric Surgeons and the Australian and NZ Association of Paediatric Surgeons. In other words, you can’t get any better rigour than what Spencer brings to the table.
Together, they imagined and designed what is now the Symulus surgical simulator for OA/TOF with innovations like the 3D-printed plastic ribcage and silicone compounds for the abnormal oesophagus and trachea replica.
Cross-discipline collaboration
To make this a reality and as close to reality as possible, Jon and Spencer collaborated with Nick Cook, a medical physicist supporting Radiology Imaging and research at the Canterbury DHB Medical Physics and Bioengineering department. Jon discovered that Nick had previously developed a 3D-printed surgical model for planning complex Maxillofacial and Orthopaedic surgeries and looked him up.
Using CT scans of real babies, Nick used his experience to work with the team to develop a life-like model of a neonate ribcage. Nick’s combination of imaging and modelling expertise was essential in developing the anatomically-accurate and life-like chest models.
Another aspect of the design was developing a synthetic skin for the simulator, alongside getting the different layers of synthetic tissues of the oesophagus and trachea to be as life-like as possible so the trainees would experience the same challenges as they would in a real operation. Plastics engineer and entrepreneur Rory Jones had this covered, and took the prototype model to the next level of commercial production quality. With Rory having successfully established his own global export business producing venting solutions for rotational moulding tools, he also brought his entrepreneurial experience and business development skills to the fore and has been critical to getting the model from the lab to the hands of those who need it.
Validity and Research
David Nair, then a final-year medical student and now surgical registrar at Christchurch Hospital, joined the Symulus Team and was responsible for getting on with the research to validate the simulator as an effective and useful training model. David didn’t have the decades of experience like Spencer or Jon, but this was an advantage as he could experience and provide feedback for the model from the perspective of a trainee.
David has also ensured rigor. In 2019, David, alongside Jon, Nick, Spencer and colleagues, conducted research with surgeons to identify the key features of an ideal simulator. Their research found that it needed to be validated, accessible, portable, affordable, ethical, and reusable. These are precisely the factors the Symulus team has delivered.
Iterative Development
These models were developed through several iterations with feedback from trainers and trainees. Using a step-wise critical appraisal approach based on literature reviews done in 2019. The team worked through each step to validate as a physical model, then as a tool for learning. The model was shown to replicate the physical neonatal anatomy, and also the surgical experience and procedural difficulty. The research also showed the simulator to be both valuable and relevant.
This collaborative spirit used in the design and validation process is also baked into the tools—with the Symulus Vision App platform enabling trainees like David to share and review their experience with a community of peers, mentors, and supervisors.
Equipping the next generation
Overall, the result is a simulator that is packed full of innovation, diverse expertise, and features that actually meet the needs of trainee surgeons and those overseeing them. With our multi-disciplinary approach, all bases have been covered. Because our simulator is co-designed and validated through rigorous research, you can trust it to be realistic, clinically-validated, and fit-for-purpose. Our EA/TEF simulator is only the beginning of the fruits of the Symulus team, with more to come.
For the next generation of surgeons, it is worth the investment. Get in touch with our team here to learn more.
