A New Portable Computerized Minimally Invasive Aortic Valve Replacement Training Simulator
Juan A. Siordia, Jr.1, Angelo J. Martellaro2, Jude S. Sauer2, Peter A. Knight1.
1University of Rochester Medical Center, Rochester, NY, USA, 2LSI Solutions, Victor, NY, USA.
OBJECTIVE: Mastering a complex surgical procedure requires extensive training. Developing the techniques and skills for minimally invasive aortic valve replacement (MI-AVR) can be prohibitively inconvenient for busy cardiac surgeons. A self-contained comprehensive training simulator platform may optimize the limited time available for both surgeons and their staff, while enabling technique refinement outside of the clinical setting.
METHODS: A computerized training system was developed to simulate the “hands-on” surgical setting of a mini-thoracotomy AVR. This portable, comprehensive simulator incorporates video image acquisition and display, realistic plastic anatomic chest wall and cardiac tissue structures that can be dissected and sutured, along with retractors and other aids to replicate surgical ergonomics. Plastic anatomic model components can be readily replaced for repeat training activities. This simulator enables cardiac surgery training with manual instruments and automated surgical devices to achieve various tasks, which may include cardioplegia catheter placement, aortotomy incision, leaflet removal, annular and sewing cuff suture placement, valve fixation and aortotomy closure.
RESULTS: This simulator successfully modeled a mini-thoracotomy AVR, providing an opportunity to hone skills toward improved surgical proficiency through the use of integrated computerized instructions, authentic tissue models and appropriate imaging. Annular sutures were placed through the right second intercostal space. Representative prosthetic valves were installed efficiently at the simulated aortic annulus and were reliably secured. The trainees’ learning experience mimicked the operating room setting while they developed a more thorough understanding of a mini-thoracotomy AVR.
CONCLUSIONS: By providing realistic training, surgical simulators can be used to enhance surgical skills and improve technique knowledge without risk to the patient. This customized MI-AVR simulator training platform provides an effective option to potentially reduce the learning curve for minimally invasive aortic valve replacement surgery and to accommodate busy cardiac surgeons.
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