Biosimulation for Minimally Invasive Valve Surgery: Upgrade of a Simulator

Background: Negative effects of the covid-19 pandemic on surgical training are widely acknowledged. To maintain and develop surgical skills, when access to real life surgery is limited, simulation training is crucial. Therefore, we further developed and amplified the fidelity of our simulator for minimally invasive valve surgery (MIVS).

Methods: We have already reported about the initial design of our simulator, which is commercially available. With the help of 3D computer-aided design and 3D printing further elements were added to the initial design. Standard synthetic material for 3D printing was used to create an inlay for a cadaver heart, that fits inside the simulator. A polyvinyl material with a texture and physical properties similar to those of skin tissue was used to simulate the skin of the chest. The front side of the simulator was re-designed to allow an elliptic shaped access and an inlet for endoscopic camera.

Results: The above described features facilitated the bio-simulation of minimally invasive valve surgery. Porcine hearts fitted perfectly inside the inlay and allowed procedures on the mitral and aortic valve with high degrees of realism. We simulated minimally invasive mitral valve repair, including ring annuloplasty, chordal reconstruction, resection and suture and edge-to-edge repair. The redesign of the simulator front side enabled us to perform the procedures in a direct and indirect fashion as well.

Conclusion: With changes in design and the development of tools for cadaver-based bio-simulation we could enhance the fidelity of our simulator further toward a life-like model. It still complies with our criteria of an ideal simulator for MIVS: easy to handle, transportable and affordable since all described tools can be provided with 3D printing. With the upgrade to cadaver-based bio-simulation our simulator design provides an ideal substitute to patients, when surgeons are trained in MIVS. Therefore, a study is planned to evaluate the training effects of our simulator using bio-simulation as a surrogate for MIVS in patients.

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Artikel online veröffentlicht:
13. Februar 2024