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Structured Team Training Improves Efficiency Of Robot-assisted Mitral Valve Surgery
Anna H. Xue1, Ala Z. Jamal1, Alison L. Ranade1, Kimberly M. Smith1, Peter P. Carnegie2, Bob B. Kiaii1.
1University of California, Davis, Sacramento, CA, USA, 2Minimally Invasive Solutions LLC, Ocoee, FL, USA.
BACKGROUND: Minimally invasive (robot-assisted) mitral valve surgery has evolved as a method to intervene on mitral valve disease without a median sternotomy. Utilizing the robot for mitral valve surgery provides the advantages of excellent visualization while allowing for precise technical movements with all degrees of freedom in a small space. Team training prior to performing complex robotic cardiac procedures is critical and essential to ensure successful outcomes. Establishing a structured simulation platform to train surgical team members to improve the efficiency of robot assisted cardiac surgery has not been studied previously. We aim to investigate the role of such a structured simulation platform in establishing a robot-assisted mitral valve surgery program.
METHODS: A total of 17 simulation cases of mitral valve repair/valvuloplasty with neochords and annuloplasty were performed. A surgical robot, thoracic cage model, and mitral valve model were used in all simulation cases. The durations of critical procedural steps were documented and compared for each simulation case.
RESULTS: Results are shown in Figure1. Docking duration decreased from 7 minutes to a low of 1 minute. Atriotomy duration decreased from 8 minutes to a low of 2 minutes during the 11th simulation case and achieved an average of 4 minutes over all simulation cases. Valvuloplasty decreased from 32 minutes to a low of 15 minutes. Annuloplasty decreased to a low of 12 minutes on simulation case 17. Atriotomy closure also decreased from a high of 27 minutes to a low of 15 minutes over the course of the simulation cases with an average of 21 minutes. Overall, the structured simulation platform steadily improved efficiency and flow of the cases and enhanced team dynamics, leading to a successful first live case with further improvement during the second live case.
CONCLUSIONS: A structured team simulation platform does improve the efficiency and flow of critical steps of robot-assisted mitral valve surgery while enhancing team dynamics. Overall, such a platform enables the surgical team to perform more complex robotic procedures at the onset of program establishment. It is a valuable and essential method to incorporate in establishing a robotic mitral valve surgery program.
LEGEND Figure 1 Figure 1: Analysis of key procedure steps. Training was clustered as Period 1, 2, and 3. UCD Trn Avg. - average training times. UCD Trn Med. m training times. UCD Live Avg. - average times of Live cases. UCD Live Med - Median Times of Live cases 
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