Short- and Long-Term Training Effect of a Physical Reality Simulator for Minimally Invasive Mitral Valve Surgery

Objectives: Minimally invasive mitral valve surgery (MIMVS) through an endoscopic right minithoracotomy is a well-established yet complex procedure demanding a challenging learning curve. We have developed a commercially available mid-fidelity physical reality simulator for MIMVS. With this study we aimed to evaluate the short and long-term training effect of the above-mentioned simulator for MIMVS.

Methods: Trainees with no previous experience in simulator training or MIMVS were divided into two groups (students, n = 8 and residents, n = 8) and performed a 5-day training course after an initial instruction on the simulator. Each trainee carried out an annuloplasty procedure implanting an annuloplasty closed ring on each training day. Scores were given by a supervisor assessing five skills (stitch depth, stitch positioning in annulus, number of needle adjustments per stitch, stitch positioning in ring, and knotting technique) throughout the procedure. The duration of the whole procedure and substeps was measured in addition. To evaluate the long-term effect of the training course, trainees performed the same procedure 4 weeks after their last training session.

Results: Trainees in the resident group were significantly older compared to the student group (p < 0.05) and had a mean surgical experience of 4.4 ± 2.8 years. All other demographic data were similar between both groups. Significant learning curves could be achieved in both groups over the course of five days with regard to total skill scores and total time duration of the performed procedure (p < 0.05). Comparing learning curves between both groups no significant difference could be seen. Long-term performance in both groups was still significantly better compared to the first training session (p < 0.05).

Conclusion: Our study showed that training with our simulator for MIMVS provided a significant enhancement of the trainee's performance. This learning effect could be even achieved in students without prior surgical experience and was still evident four weeks later in both groups. We therefore strongly recommend the use of our simulator in simulation-based surgical education of cardiac surgeons interested in MIMVS.