The Contribution of 3D Printing in the Minimally Invasive Surgery of Pectus Excavatum: A Report Case of The First Experience of A Moroccan Center

Introduction: The Nuss procedure is a highly technical, minimally invasive alternative to the open corrective surgery of Pectus Excavatum of which perioperative complications depend heavily on the surgeon’s experience and caseload. To overcome the learning curve, and allow faster proficiency, simulation-based teaching has been adopted in many teaching hospitals, either virtual, physical, or hybrid. Our study aims to show the impact of a high fidelity physical Nuss simulator on surgeon’s skill acquisition. Material and methods: We conducted a two-day training workshop using a physical Nuss simulator targeting surgeons and surgical trainees with no prior experience in performing this procedure; using a rating scale from 1 to 5, independent expert surgeons assessed performances by evaluating 15 key steps of the Nuss procedure of two participants groups, one of which (group 1) had two training sessions on the mannequin and the other (group 2) only one. Following the simulation, participants rated their feedback on a 5-point Likert scale. Results: Participants who did the simulation twice scored a mean of 68.8 /75 on the second day evaluation; while the participants who only had the second-day simulation, had a mean of 49.6/75 (with a significant p-value < 0.001). Concerning feedback, for the realism of the simulator, the percentages of participants who gave a score of 4/5 or higher (agree or strongly agree) were 100% for sternal elevation, 80% for introducer manipulation during mediastinal dissection and 85% for overall simulation realism. For the pedagogic utility of the simulator, 16 participants (80%) chose a rating of 4/5 or higher (agree or strongly agree), while the remaining 20% chose a score of 3/5 (neutral). Regarding self confidence in eventually replicating the procedure, participants of the first group had a mean of 4.2/5, The second group a mean score of 2.7/5 with a significant p-value of 0.002. Conclusion: Our study suggests that a fully physical, 3D-printed, simulator of the Nuss procedure is a better alternative to traditional surgical teachings of PE’s minimally invasive corrective surgery.