Cravano Sara Maria, Carmine Annalisa Di, De Maio Chiara, Di Mitri Marco, Bisanti Cristian, Collautti Edoardo, Libri Michele, D'Antonio Simone, Gargano Tommaso, Ciardini Enrico, Lima Mario
Pediatric Surgery Department, IRCCS Sant'Orsola-Malpighi, Alma Mater Studiorum, University of Bologna, 40138 Bologna, Italy.
Pediatric Surgery Department, IRCCS Meyer, 50139 Florence, Italy.
Healthcare (Basel). 2025 Jul 17;13(14):1720. doi: 10.3390/healthcare13141720.
Minimally invasive surgery (MIS) is increasingly adopted in pediatric surgical practice, yet it demands specific technical skills that require structured training. Simulation-based education offers a safe and effective environment for skill acquisition, especially in complex procedures such as thoracoscopic repair of esophageal atresia with tracheoesophageal fistula (EA-TEF). Objective: This study aimed to evaluate the effectiveness of a 3D-printed simulator for training pediatric surgeons in thoracoscopic EA-TEF repair, assessing improvements in operative time and technical performance. A high-fidelity, 3D-printed simulator replicating neonatal thoracic anatomy was developed. Six pediatric surgeons at different training levels performed eight simulation sessions, including fistula ligation and esophageal anastomosis. Operative time and technical skill were assessed using the Stanford Microsurgery and Resident Training (SMaRT) Scale. All participants showed significant improvements. The average operative time decreased from 115.6 ± 3.51 to 90 ± 6.55 min for junior trainees and from 100.5 ± 3.55 to 77.5 ± 4.94 min for senior trainees. The mean SMaRT score increased from 23.8 ± 3.18 to 38.3 ± 3.93. These results demonstrate a clear learning curve and enhanced technical performance after repeated sessions. Such 3D-printed simulation models represent an effective tool for pediatric MIS training. Even within a short time frame, repeated practice significantly improves surgical proficiency, supporting their integration into pediatric surgical curricula as an ethical, safe, and efficient educational strategy.
微创手术（MIS）在小儿外科实践中的应用越来越广泛，但它需要特定的技术技能，而这些技能需要进行结构化培训。基于模拟的教育为技能获取提供了一个安全有效的环境，特别是在诸如胸腔镜下食管闭锁合并气管食管瘘（EA-TEF）修复等复杂手术中。目的：本研究旨在评估用于培训小儿外科医生进行胸腔镜EA-TEF修复的3D打印模拟器的有效性，评估手术时间和技术操作的改善情况。开发了一种高保真的、复制新生儿胸部解剖结构的3D打印模拟器。六名处于不同培训水平的小儿外科医生进行了八次模拟训练，包括瘘管结扎和食管吻合术。使用斯坦福显微手术和住院医师培训（SMaRT）量表评估手术时间和技术技能。所有参与者均有显著改善。初级学员的平均手术时间从115.6±3.51分钟降至90±6.55分钟，高级学员的平均手术时间从100.5±3.55分钟降至77.5±4.94分钟。SMaRT平均得分从23.8±3.18提高到38.3±3.93。这些结果表明，经过反复训练后，存在明显的学习曲线且技术操作得到了提高。这种3D打印模拟模型是小儿MIS培训的有效工具。即使在短时间内，反复练习也能显著提高手术熟练度，支持将其作为一种符合伦理、安全且高效的教育策略纳入小儿外科课程。
