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Low-Fidelity Simulator for the Standardized Training of Fetoscopic Meningomyelocele Repair

Belfort, Michael, A., MD, PhD; Whitehead, William, E., MD; Bednov, Andrey, PhD; Shamshirsaz, Alireza, A., MD

doi: 10.1097/AOG.0000000000002406
Contents: Procedures and Instruments

BACKGROUND: Fetoscopic meningomyelocele repair in a gas-filled uterus is a new technique performed in very few centers. There are few opportunities as well as ethical prohibitions on the initial development and subsequent refinement of innovative fetal surgery techniques in humans, and using an animal model is both very expensive and logistically difficult.

METHOD: We developed a low-fidelity endoscopic fetal surgery simulation using a plastic doll and pieces of chicken breast to simulate a fetal meningomyelocele, and a polyurethane ball to simulate a gas-filled uterus, along with a standard endoscopy system and instruments.

EXPERIENCE: A unique two-port technique with significant differences from the standard laparoscopic surgery procedure was developed and refined through an iterative phase into a standardized methodology, and the simulator was then used to train three other teams to perform standardized fetoscopic meningomyelocele repair.

CONCLUSION: A low-fidelity fetoscopic surgery simulator is a useful tool for developing new fetoscopic operations and for training multidisciplinary fetal surgery teams without the need for extensive use of an animal model. This simulator may be used to further explore the human uterus as a new surgical space for additional fetal surgeries.

A fetal surgery simulator was built and used to develop and refine the technique and skills in fetoscopic meningomyelocele repair.

Texas Children’s Fetal Center and the Departments of Obstetrics and Gynecology and Neurosurgery, Baylor College of Medicine, Houston, Texas.

Corresponding author: Michael A. Belfort, MD, PhD, Texas Children's Pavilion for Women, Texas Medical Center, 6651 Main Street, Suite F1096, Houston, TX 77030; email:

Financial Disclosure The authors did not report any potential conflicts of interest.

The authors thank our scientific collaborators who built simulators and developed their own programs using our two-port technique: Drs. Yair Blumenfeld, Yasser El-Sayed, Karl Sylvester, and Gerry Grant (Stanford University, Palo Alto, California); Drs Gerardo Sepulveda, Gabriel Villagomez, Fernando Montez, and Paulo Rubio (Christus Muguerza Hospital, Monterrey, Mexico); and Drs. Ahmet Baschat, Jena Miller, and Edward Ahn (Johns Hopkins University, Baltimore, Maryland).

Each author has indicated that he has met the journal's requirements for authorship.

© 2018 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.