TissueDB/Simulators/Thoracoscopic Diaphragmatic Hernia Repair Simulator (Barsness)
The Thoracoscopic Diaphragmatic Hernia Repair Simulator (Barsness) is a neonatal-scale synthetic model for practising minimally invasive thoracoscopic repair of congenital diaphragmatic hernia.[1] The model combines a 3D-printed ABS neonatal rib cage, a platinum-cured silicone stabilising base, an artificial diaphragm with a posterolateral defect, herniated synthetic intestines and a replaceable silicone-rubber skin overlay.
| Field | Details |
|---|---|
| Features and Basic Operation | The trainee practises placement of intercostal ports, reduction of synthetic bowel through the diaphragmatic defect and sutured closure of the defect. The silicone-rubber skin overlay is replaced between trainees. The rib cage reproduces neonatal thoracic dimensions and intercostal spaces. The model represents the left chest. |
| Current Development Status | Developed and pilot-tested by Barsness, Rooney and Davis. The 2013 evaluation provided early validity evidence relating to test content and internal structure. The authors identified the need for further refinement and additional validity evidence before use as a high-stakes assessment instrument. Transfer to clinical performance or patient outcomes was not established. |
| Estimated Build Time and Cost | - US$218 total source-reported simulator cost. Source component costs: 3D-printed ABS rib cage US$200; stabilising silicone base US$8; replaceable silicone-rubber skin US$8; artificial diaphragm and intestines US$2 combined. |
| Specialized Tools and Equipment | For fabrication: a rapid-prototyping / 3D-printing system capable of printing ABS and SolidWorks CAD software for the rib-cage design. For training use: standard thoracoscopic ports and instruments and suture for closure of the diaphragmatic defect. |
| Version | Version 1 — Barsness, Rooney and Davis 2013 baseline simulator |
| Development Team Contact Information | Katherine A. Barsness — Division of Pediatric Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine; corresponding author: kbarsness@luriechildrens.org. Deborah M. Rooney — Department of Medical Education, University of Michigan Medical School. Lauren M. Davis — Center for Simulation Technology and Immersive Learning, Northwestern University Feinberg School of Medicine. |
Tissues
| Tissue | Qty | Material | Cost | Notes |
|---|---|---|---|---|
| Diaphragm | 1 | Synthetic material — material not specified in source | US$2 combined with synthetic intestines | Artificial diaphragm with a posterolateral defect. It is anchored to the rib cage using eyehooks around the 11th rib and is sutured during the simulated repair. Barsness et al. do not identify its material chemistry. Do not assign platinum-cured silicone or another material to this tissue without a direct source. |
| Small Intestine | - | Synthetic material — material not specified in source | Included in the US$2 combined diaphragm/intestine cost | Synthetic intestine is herniated through the diaphragmatic defect and reduced during the simulated repair. The source does not specify the material or quantity. The evaluation identified the synthetic intestines as the least realistic tissue component and noted poor haptic fidelity. |
| Skin | 1 overlay; replaced between trainees | Synthetic silicone rubber | US$8 | Silicone-rubber overlay covering the apparatus. It provides the external access surface and is replaced between trainees. The source reported a realism rating of 3.88/5 for the skin component. |
| Bone — neonatal rib cage | 1 | 3D-printed ABS plastic | US$200 | To-scale left-sided neonatal rib cage with scapulae, designed from thoracic measurements for a term neonate at approximately the 50th percentile for age. The printed ribs and intercostal spaces provide the bony thoracic anatomy used for port placement and repair. |
Structural Parts
| Part Name | Qty | Material | Cost | Notes |
|---|---|---|---|---|
| Stabilising base | 1 | Platinum-cured silicone rubber | US$8 | Supports and stabilises the 3D-printed rib cage during the simulated procedure. Platinum-cured silicone belongs to this structural base; it must not be propagated to the artificial diaphragm. |
| Diaphragm anchor hardware | Several | Eyehooks | - | Placed around the 11th rib to anchor the artificial diaphragm to the rib cage. The source does not provide a separate eyehook cost. |
Build Instructions
Phase 1: Design the neonatal rib cage
Step 1. Obtain measurements of the ribs, thoracic space and scapulae for a term neonate at approximately the 50th percentile for age.
The development team obtained the relevant dimensions through a literature review.
Step 2. Use SolidWorks CAD software to create the neonatal thoracic model.
The source describes a left-sided rib cage with scapulae matching neonatal thoracic dimensions.
Step 3. Model the left chest configuration used by the Barsness simulator.
Phase 2: Fabricate the rib cage and stabilising base
Step 1. Produce the rib cage in acrylonitrile-butadiene-styrene (ABS) using a rapid-prototyping / 3D-printing process.
Source limitation: the source identifies ABS and the rapid-prototyping approach but does not provide a complete reproducible set of printer settings here. Do not invent layer height, infill, print orientation or other unspecified parameters.
Step 2. Make a stabilising base from platinum-cured silicone rubber.
Step 3. Mount or support the printed rib cage on the stabilising base as described by the simulator configuration.
Phase 3: Install the diaphragm and herniated viscera
Step 1. Prepare an artificial diaphragm with a posterolateral defect.
Source limitation: Barsness et al. describe this component as synthetic but do not identify its material. Do not infer that it is made from the platinum-cured silicone used for the stabilising base.
Step 2. Anchor the diaphragm to the rib cage with eyehooks positioned around the 11th rib.
Step 3. Place the synthetic intestines through the defect to reproduce the herniated-bowel configuration.
Source limitation: the source does not identify the material or quantity of the artificial intestines.
Phase 4: Apply the skin overlay
Step 1. Cover the apparatus with the synthetic silicone-rubber skin.
The skin overlay is a consumable element and is replaced between trainees.
Training use
The simulator supports rehearsal of:
- intercostal thoracoscopic port placement;
- reduction of the herniated synthetic intestine; and
- sutured closure of the diaphragmatic defect.
Standard thoracoscopic instruments and ports are required for use.
Evidence and scope
The 2013 evaluation provides early validity evidence for test content and internal structure.
The simulator should not be described as demonstrating:
- clinical skills transfer;
- patient-outcome validity; or
- sufficient validity evidence for high-stakes trainee assessment.
The authors identified synthetic-tissue haptic fidelity as an area requiring improvement.
Anatomy and material boundaries
- 3D-printed ABS represents the neonatal bony rib cage.
- Synthetic silicone rubber represents Skin.
- Platinum-cured silicone rubber is the stabilising base only.
- The artificial Diaphragm material is not specified in the 2013 source.
- The synthetic Small Intestine material is not specified.
- Do not create a platinum-cured-silicone → Diaphragm relationship from this simulator.
- No Dura, Brain or unrelated anatomy relationship is introduced.
- No Structure implementation is introduced by this correction.
| Authors | Arturopelayo |
|---|---|
| License | CC-BY-SA-4.0 |
| Cite as | Arturopelayo (2026). "TissueDB/Simulators/Thoracoscopic Diaphragmatic Hernia Repair Simulator (Barsness)". Appropedia. Retrieved September 13, 2026. |
- ↑ Barsness KA, Rooney DM, Davis LM. "The development and evaluation of a novel thoracoscopic diaphragmatic hernia repair simulator." Journal of Laparoendoscopic & Advanced Surgical Techniques. 2013;23(8):714–718. DOI: 10.1089/lap.2013.0196. PMID: 23789735.