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Assessing a new coarctation repair simulator based on real patient’s anatomy

Published online by Cambridge University Press:  04 December 2019

Jacek Kleszcz Open the ORCID record for Jacek Kleszcz [Opens in a new window] ,
Michał Sobieraj ,
Tomasz Nałęcz ,
Patrick O. Myers ,
Michał Wojtalik  and
Wojciech Mrówczyński
Jacek Kleszcz*
Affiliation:
Department of Paediatric Cardiac Surgery, Poznan University of Medical Sciences, Poznan, Poland
Michał Sobieraj
Affiliation:
Department of Paediatric Cardiac Surgery, Poznan University of Medical Sciences, Poznan, Poland
Tomasz Nałęcz
Affiliation:
Department of Paediatric Cardiac Surgery, Poznan University of Medical Sciences, Poznan, Poland
Patrick O. Myers
Affiliation:
Department of Cardio-Vascular Surgery, Geneva University Hospitals, Geneva, Switzerland
Michał Wojtalik
Affiliation:
Department of Paediatric Cardiac Surgery, Poznan University of Medical Sciences, Poznan, Poland
Wojciech Mrówczyński
Affiliation:
Department of Paediatric Cardiac Surgery, Poznan University of Medical Sciences, Poznan, Poland
*
Author for correspondence: J. Kleszcz, Department of Pediatric Cardiac Surgery, Poznan University of Medical Sciences, 27/33, Szpitalna St., 60-572 Poznan, Poland. Tel: +48 618 49 12 77; Fax: +4 618 66 91 30; E-mail: [email protected]
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Abstract

Objectives:

To perform the preliminary tests of coarctation of aorta repair trainer, evaluate the surgical properties of the simulation and to assess and enhance residents’ skills.

Methods:

Single patient’s angio-CT anatomy data were converted into magnified 3D-printed model of aortic coarctation with hypoplastic aortic arch, serving for creation of a mould used during wax copies casting. Wax cores were painted with six layers of elastic silicone and melted, yielding phantoms that were consecutively fixed in a mounting with and without a thoracic wall. Simulation included: proximal and distal aortic arch clamping, incision of its lesser curvature, extended end-to-end anastomosis with 7-0 suture. A head-mounted camera video recording enabled anastomosis time and mean one suture bite time evaluation. Leakage assessment was done by a water test.

Results:

Two residents performed nine simulations each. Last four runs were performed with thoracic wall attached. All phantoms performed well, enabling tissue-like handling and cutting, excellent suture retention, and satisfactory elasticity. Median anastomosis times were 22′33″ and 24′47″ for phantoms without and with thoracic wall (p = not significant (NS)). Median times needed to pass suture through one side of anastomosis and regrasp needle were, respectively, 9″ and 13″ (p < 0.001). Median total number of leakages per phantom equalled 2 for both difficulty levels. There were no significant inter-resident differences in all assessed parameters.

Conclusions:

This medium-fidelity aortic coarctation repair trainer showed its feasibility in replication of major critical steps of the real operation. Objective surgical efficiency parameters could be obtained from each simulation and compared between trainees and at different adjustable difficulty levels.

Keywords

Coarctationaortasimulatoreducationtrainingcongenital
Type
Original Article
Information
Cardiology in the Young , Volume 29 , Issue 12 , December 2019 , pp. 1517 - 1521
Copyright
© Cambridge University Press 2019 

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References

Torok, RD, Campbell, MJ, Fleming, GA, Hill, KD. Coarctation of the aorta: management from infancy to adulthood. World J Cardiol 2015; 7: 765–775.CrossRefGoogle Scholar
Al Balushi, A, Sunny, Z, Al Senaidi, K. Coarctation of the aorta, known yet can be missed. Oman Med J 2013; 28: 204–206.CrossRefGoogle ScholarPubMed
Azzie, G, Gerstle, JT, Nasr, A, et al. Development and validation of a pediatric laparoscopic surgery simulator. J Pediatr Surg 2011; 46: 897–903.CrossRefGoogle ScholarPubMed
Carter, YM, Wilson, BM, Hall, E, Marshall, MB. Multipurpose simulator for technical skill development in thoracic surgery. J Surg Res 2010; 163: 186–191.CrossRefGoogle ScholarPubMed
Macfie, RC, Webel, AD, Nesbitt, JC, Fann, JI, Hicks, GL, Feins, RH. “Boot camp” simulator training in open hilar dissection in early cardiothoracic surgical residency. Ann Thorac Surg 2014; 97: 161–166.CrossRefGoogle ScholarPubMed
Ito, J, Shimamoto, T, Sakaguchi, G, Komiya, T. Impact of novel off-pump coronary artery bypass simulator on the surgical training. Gen Thorac Cardiovasc Surg 2013; 61: 270–273.CrossRefGoogle ScholarPubMed
Verberkmoes, NJ, Verberkmoes-Broeders, EM. A novel low-fidelity simulator for both mitral valve and tricuspid valve surgery: the surgical skills trainer for classic open and minimally invasive techniques. Interact Cardiovasc Thorac Surg 2012; 16: 97–101.CrossRefGoogle ScholarPubMed
Shaikhrezai, K, Khorsandi, M, Brackenbury, ET, et al. How to make an aortic root replacement simulator at home. J Cardiothorac Surg 2015; 10: 18.CrossRefGoogle ScholarPubMed
Fedorov, A, Beichel, R, Kalpathy-Cramer, J, et al. 3D Slicer as an image computing platform for the quantitative imaging network. Magn Reson Imaging 2012; 30: 1323–1341.CrossRefGoogle ScholarPubMed
Cignoni, P, Callieri, M, Corsini, M, Dellepiane, M, Ganovelli, F, Ranzuglia, G. MeshLab: an open-source mesh processing tool, Sixth Eurographics Italian Chapter Conference, 2008:129–136.Google Scholar
Alonso-Silverio, GA, Pérez-Escamirosa, F, Bruno-Sanchez, R, et al. Development of a laparoscopic box trainer based on open source hardware and artificial intelligence for objective assessment of surgical psychomotor skills. Surg Innov 2018; 25: 380–388.CrossRefGoogle ScholarPubMed
Millán, C, Rey, M, Lopez, M. LAParoscopic simulator for pediatric ureteral reimplantation (LAP-SPUR) following the Lich-Gregoir technique. J Pediatr Urol 2018; 14: 137–143.CrossRefGoogle ScholarPubMed
Okuda, Y, Bryson, EO, DeMaria, S , Jr, et al. The utility of simulation in medical education: what is the evidence? Mt Sinai J Med 2009; 76: 330–343.CrossRefGoogle ScholarPubMed
Willaert, WI, Aggarwal, R, Van Herzeele, I, Cheshire, NJ, Vermassen, FE. Recent advancements in medical simulation: patient-specific virtual reality simulation. World J Surg 2012; 36: 1703–1712.CrossRefGoogle ScholarPubMed
Abla, AA, Lawton, MT. Three-dimensional hollow intracranial aneurysm models and their potential role for teaching, simulation, and training. World Neurosurg 2015; 83: 35–36.CrossRefGoogle ScholarPubMed
Chueh, JY, Wakhloo, AK, Gounis, MJ. Neurovascular modeling: small-batch manufacturing of silicone vascular replicas. AJNR Am J Neuroradiol 2009; 30: 1159–1164 CrossRefGoogle ScholarPubMed
Mashiko, T, Otani, K, Kawano, R, et al. Development of three-dimensional hollow elastic model for cerebral aneurysm clipping simulation enabling rapid and low cost prototyping. World Neurosurg 2015; 83: 351–361.CrossRefGoogle ScholarPubMed
Cheung, CL, Looi, T, Lendvay, TS, Drake, JM, Farhat, WA. Use of 3-dimensional printing technology and silicone modeling in surgical simulation: development and face validation in pediatric laparoscopic pyeloplasty. J Surg Educ 2014; 71: 762–767.CrossRefGoogle ScholarPubMed
Sardari Nia, P, Heuts, S, Daemen, J, et al. Preoperative planning with three-dimensional reconstruction of patient’s anatomy, rapid prototyping and simulation for endoscopic mitral valve repair. Interact Cardiovasc Thorac Surg 2017; 24: 163–168.Google ScholarPubMed
Håkansson, A, Rantatalo, M, Hansen, T, Wanhainen, A. Patient specific biomodel of the whole aorta – the importance of calcified plaque removal. Vasa 2011; 40: 453–459.CrossRefGoogle ScholarPubMed
Schmauss, D, Haeberle, S, Hagl, C, Sodian, R. Three dimensional printing in cardiac surgery and interventional cardiology: a single-centre experience. Eur J Cardiothorac Surg 2015; 47: 1044–1052.CrossRefGoogle ScholarPubMed
Ma, XJ, Tao, L, Chen, X, et al. Clinical application of three dimensional reconstruction and rapid prototyping technology of multislice spiral computed tomography angiography for the repair of ventricular septal defect of tetralogy of Fallot. Genet Mol Res 2015; 14: 1301–1309.CrossRefGoogle ScholarPubMed
Valverde, I, Gomez, G, Gonzalez, A, et al. Three-dimensional patient specific cardiac model for surgical planning in Nikaidoh procedure. Cardiol Young 2015; 25: 698–704.CrossRefGoogle ScholarPubMed
Hermsen, JL, Yang, R, Burke, TM, et al. Development of a 3-D printing-based cardiac surgical simulation curriculum to teach septal myectomy. J Thorac Cardiovasc Surg 2018; 156: 1139–1148.CrossRefGoogle ScholarPubMed
Sardari Nia, P, Olsthoorn, J, Heuts, S, Maessen, J. Suturing map for endoscopic mitral valve repair developed on high-fidelity endoscopic simulator. Multimed Man Cardiothorac Surg 2018. doi: 10.1510/mmcts.2018.038 CrossRefGoogle Scholar