10.25373/ctsnet.8035631.v1
Peyman Sardari Nia
Peyman
Sardari Nia
From Bench to Reality: Development of Simulation, 3D Printing, and Air-Pilot-Training Concept Course for Endoscopic Mitral Valve Surgery
CTSNet
2019
Cardiac
Mitral
Valve
Disease
Minimally Invasive
Education
Simulation
Endoscopic
Surgery
2019-04-30 18:14:44
Media
https://ctsnet.figshare.com/articles/media/From_Bench_to_Reality_Development_of_Simulation_3D_Printing_and_Air-Pilot-Training_Concept_Course_for_Endoscopic_Mitral_Valve_Surgery/8035631
<p>Endoscopic
mitral valve repair is one of the most difficult procedures to learn. The
learning curve is steep. This steep learning curve has partially to do with the
fact that the operation is done with long-shafted instruments, with surgeon
looking at the monitor rather than into the wound. Acquiring endoscopic skills
with long-shafted instruments is a process that no one can escape from, and acquiring
these skills in patients is not logical or efficient. </p>
<p>In 2012, the
author wrote a project to develop a high-fidelity minimally invasive mitral
valve simulator (MIMVS). Fidelity in simulation has traditionally been defined as 'the degree to
which the simulator replicates reality (1). Obviously, a simulation platform should be realistic
and mimic the set-up of a procedure. Additional to this and fundamental to
learning, is the need for feedback. There is no efficient learning without
feedback and it has been shown that if the feedback is given in an objective
and reproducible manner the learning process is more efficient (2). Therefore,
the aim of the project was to create a platform that was realistic and that it
could provide feedback regarding the skills that one would like to develop, a
platform that one could use to train oneself objectively and repeatedly in a
reproducible manner. </p>
<p>In 2013, a
prototype was developed and the author used the prototype to start the
endoscopic mitral valve program and used it during the start-up of the program
to refine his own skills. Because of the success of the platform, the group
received funding from Maastricht University Medical Center in The Netherlands to
develop an industrialized platform. An engineering group was assembled to
actualize the author’s ideas. This group was able to create a high-fidelity
simulator that provides a platform on which endoscopic skills can be trained
repeatedly and objectively. Additionally, the simulator provides objective
assessment and feedback, which is essential in any simulator-based training. The
disposable mitral valve is made of special silicone developed by the author’s
group that provides a true suturing experience.</p>
<p>The group was
awarded the European Association for Cardio-Thoracic Surgery’s (EACTS) Techno-College
Innovation Award in 2014, and a <a href="https://www.ctsnet.org/article/high-fidelity-minimally-invasive-mitral-valve-repair-simulator">video
on the innovation was published on CTSNet</a> in 2014 (3). In this video, the
author envisioned using this platform to train surgeons and also to use it for
preoperative planning, applying the 3D technology. Ever since, the group has
tried to bring this innovation and these visions from bench to reality. They <a href="https://doi.org/10.1016/j.jtcvs.2018.09.014">recently published the
process of the development of this simulator in <i>The Journal of Thoracic and Cardiovascular Surgery</i></a> to
stimulate development in this field. Ninety-nine senior surgeons during various
educational programs validated the platform for training of minimally invasive
mitral valve surgery (4). </p>
<p>Additionally,
the group developed a
process for modeling and three-dimensional (3D) printing of different mitral
valve diseases for procedural planning and simulation based on 3D transesophageal
echocardiography (TEE), and <a href="https://academic.oup.com/ejcts/article/55/3/543/5092031">published these
results recently in the <i>European
Journal of Cardio-Thoracic Surgery</i></a>. Disposable, 3D-printed,
pathological, silicone replica valves can be mounted into the simulator so that
one can also be trained in any repair technique on any pathology of the mitral
valve (5). <a href="https://doi.org/10.1093/icvts/ivw308">Another publication also provided the
proof of concept</a> for the use of 3D printing and simulation for planning
procedures in prospective patients (6).</p>
<p>In 2015, the
EACTS Endoscopic
Port-Access Mitral Valve Repair Drylab Training was founded using the
high-fidelity simulators. This course has been <a href="https://www.eacts.org/educational-events/programme/endoscopic-mvr-april19/">organized
15 times in Maastricht</a>. The
course was designed based on the latest educational science and is structured
like an air-pilot-training concept course, starting with technical and
theoretical pre-assessment and two subsequent days of intensive training on
simulators, mixed with interactive presentations and videos regarding all
aspects of the endoscopic mitral repair program. The course ends with technical
and theoretical post-assessment. </p>
<p>Learn more: https://www.ctsnet.org/article/bench-reality-development-simulation-3d-printing-and-air-pilot-training-concept-course</p>