Development and use of a high-fidelity simulator for fetal endotracheal balloon occlusion (FETO) insertion and removal


  • Funding sources: This project is funded by the Network of Excellence in Simulation for Clinical Teaching and Learning, Ontario, Canada; the Flemish Government (Instituut voor Wetenschap en Technologie; IWT/070715; the Fonds Wetenschappelijk Onderzoek Vlaanderen; and the Wellcome trust.

  • Conflicts of interest: Francis Lebouthillier owns a medical simulator company that sells the model described in this report.




The objective of this article is to describe the development of an anatomically accurate simulator in order to aid the training of a perinatal team in the insertion and removal of a fetal endoscopic tracheal occlusion (FETO) balloon in the management of prenatally diagnosed congenital diaphragmatic hernia.


An experienced perinatal team collaborated with a medical sculptor to design a fetal model for the FETO procedure. Measurements derived from 28-week fetal magnetic resonance imaging were used in the development of an anatomically precise simulated airway within a silicone rubber preterm fetal model. Clinician feedback was then used to guide multiple iterations of the model with serial improvements in the anatomic accuracy of the simulator airway.


An appropriately sized preterm fetal mannequin with a high-fidelity airway was developed. The team used this model to develop surgical skills with balloon insertion, and removal, and to prepare the team for an integrated response to unanticipated delivery with the FETO balloon still in situ.


This fetal mannequin aided in the ability of a fetal therapy unit to offer the FETO procedure at their center for the first time. This model may be of benefit to other perinatal centers planning to offer this procedure.