Portable 3d-printed Tele-simulator For Endoscopic Mitral Valve Surgery.
Peyman Sardari Nia, Umar Imran Hamid, Marvin Fillet, Shokoufeh Cheheili Sobbi, jos Maessen.
Maastricht University Medical Center, Maastricht, Netherlands.
Objectives:Simulation-based training is valuable tool for training surgeons in new technology. Here we report the development of fully 3D-printed modular portable tele-simulator platform for minimally invasive mitral valve surgery with possibility to be connected to any smart-device with live-connectivity that can be used for stand-alone training or tele-simulation training. MethodsThe model is created with computer-aided board design software and printed with a digital light processing 3D printer and a post curing machine. The platform has a central chest plate with surrounding guides for suture placement. The centre of the chest plate has an opening to simulate a utility port. Furthermore, the platform has inner module composed of a 3D-printed left ventricle and atrium with fittings for disposable mitral and papillary muscles. The device is provided with a universal serial bus (USB)-c hub, connected to a USB charger, to power to a smart device, light emission diode (LED) array and USB camera. The hub provides the image stream to the tablet on which the valve footage is displayed for simulation and for recording (Figure 1). Two tele-simulation courses were designed and organized in March and December 2022. The platform was provided to 10 surgeons from Oceania, Asia, Europe, and North America. Feedback was obtained from participants about the platform. A technical pre- and post-assessment was carried based on accuracy and time taken to place a suture at the anterior and posterior annulus.ResultsThe surgeons tested the simulator strongly agreed that it was an excellent training tool for minimally invasive mitral valve surgery. There was a significant improvement in the accuracy of suture placement (anterior - 50% vs 100%, posterior - 33% vs 100%) following completion of the course (p = < 0.0001). Similarly, there was a significant reduction in the time to place sutures (40 seconds vs 15 seconds) at the mitral valve annulus (p = 0.005). ConclusionTele-simulation for surgical training is feasible and is as effective as in-person training. This novel tele-simulator could make the surgical education for endoscopic mitral valve surgery more accessible. 
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