In surgery, as in life, practice makes perfect. But in the case of a cleft lip, practice is tricky, because a mistake can result in permanent scarring or disfigurement of a child’s face. This was the problem Carolyn Rogers-Vizena, MD, a plastic and oral surgeon in the Cleft Lip and Palate Program at Boston Children’s Hospital, brought to the SIMPeds Engineering Studio. She needed a safer hands-on way to teach cleft lip surgery to residents and students.
“Very minute slip-ups can cause scarring that stays with a child as they grow. So as a surgeon it’s hard to let go of the reins and let my trainees take over,” says Rogers-Vizena.
Rogers-Vizena reached out to Andrew Hosmer, Project Manager at SIMPeds Engineering, part of Boston Children’s simulator program. SIMPeds is a collaborative cohort of engineers, doctors, educators, scientists, and business leaders devoted to increasing clinician preparedness through high-fidelity simulation. Hosmer and his fellow engineers spend their days creating “trainers” — highly realistic anatomical replicas that enable providers and students to practice procedures that can’t be learned on live patients.
“Ultimately, we’re in service to the hospital, with a purpose to train and reduce fear,” Hosmer says.
A collaborative effort
Hosmer, Rogers-Vizena, her research fellow Francesca Saldanha, MBBChir, and SIMPeds senior engineering manager Stephen Wilson all came together to create the cleft lip trainer. The creation process took over 300 hours, with all sides bringing their unique points of view to the table. Rogers-Vizena and Saldanha started at the computer, where they poured over imaging data from multiple children with cleft lip.
With Hosmer they tweaked the images into a digital 3D model. Then Hosmer 3D-printed the base and bony facial structures. The cartridge that fits on top, complete with lip, nose and gum, is made of silicone rubber. Rogers-Vizena and Saldanha tested out how the materials responded to the touch of their hands or the pull of a needle, and Hosmer tweaked the formulation based on their comments. The trainer had to not only be the right size and shape, but it also had to include the layers of skin, muscle, cartilage and feel true to life under the surgeon’s fingers.
“We worked through different hardnesses and stretchinesses,” says Rogers-Vizena. The team focused on authenticity down to the smallest details, like the ability to accurately line up the right colors of flesh on the lip line when sewing the lip together. The trainers are disposable once they have been practiced on, and the head-shaped base is reusable.
Putting the trainer to work
A second phase of refinement is in the works, with plans to make the trainer less expensive to manufacture and more efficient to use. Rogers-Vizena then wants to get the trainer into the hands of craniofacial surgery trainees on a wider scale. “My long-term vision is that it becomes part of standard curriculum for teaching cleft lip surgery,” she says.
Rogers-Vizena also has global health goals for the trainer. Cleft lip occurs at high rates in certain low resource countries due to environmental and genetic factors, and she thinks that the trainers can be used to teach cleft lip surgery to local doctors in those areas, rather than rely on medical missions to perform the operations. “Some surgeons doing cleft care in low resource environments aren’t specifically trained. If you can conduct an intensive workshop using simulation, you can get someone trained and quickly performing these procedures.”
Learn more about Boston Children’s Cleft Lip and Palate Program.