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Validation of a high-fidelity training model for fetoscopic spina bifida surgery

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Luc Joyeux, Allan Javaux, Mary P. Eastwood, Felix R. De Bie, Gert Van den Bergh, Rebecca S. Degliuomini, Simen Vergote, Talita Micheletti, Geertje Callewaert, Sebastien Ourselin, Paolo De Coppi, Frank Van Calenbergh, Emmanuel Vander Poorten, Jan Deprest

Original languageEnglish
Article number6109
JournalScientific Reports
Issue number1
PublishedDec 2021

Bibliographical note

Funding Information: LJ is supported by an Innovative Engineering for Health award by the Wellcome Trust (WT101957) and the Engineering and Physical Sciences Research Council (EPSRC) (NS/A000027/1). AJ is supported by a grant from The Research Foundation – Flanders (FWO) [SB/1S63117N]. MPD and TM were funded with support of the Erasmus + Programme of the European Union (Framework Agreement number: 2013–0040). FDB is supported by a Fulbright Research grant. PDC is supported by the National Institute for Health Research (NIHR-RP-2014-04-046) and the BRC NIHR GOSH. JD was a Clinical Researcher of the FWO (FWO- and is currently supported by the Great Ormond Street Hospital Charity fund. Publisher Copyright: © 2021, The Author(s). Copyright: Copyright 2021 Elsevier B.V., All rights reserved.

King's Authors


Open fetal surgery for spina bifida (SB) is safe and effective yet invasive. The growing interest in fetoscopic SB repair (fSB-repair) prompts the need for appropriate training. We aimed to develop and validate a high-fidelity training model for fSB-repair. fSB-repair was simulated in the abdominal cavity and on the stomach of adult rabbits. Laparoscopic fetal surgeons served either as novices (n = 2) or experts (n = 3) based on their experience. Technical performance was evaluated using competency Cumulative Sum (CUSUM) analysis and the group splitting method. Main outcome measure for CUSUM competency was a composite binary outcome for surgical success, i.e. watertight repair, operation time ≤ 180 min and Objective-Structured-Assessment-of-Technical-Skills (OSATS) score ≥ 18/25. Construct validity was first confirmed since competency levels of novices and experts during their six first cases using both methods were significantly different. Criterion validity was also established as 33 consecutive procedures were needed for novices to reach competency using learning curve CUSUM, which is a number comparable to that of clinical fSB-repair. Finally, we surveyed expert fetal surgeons worldwide to assess face and content validity. Respondents (26/49; 53%) confirmed it with ≥ 71% of scores for overall realism ≥ 4/7 and usefulness ≥ 3/5. We propose to use our high-fidelity model to determine and shorten the learning curve of laparoscopic fetal surgeons and retain operative skills.

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