Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, The Netherlands; Faculty of Health, Medicine and Life Sciences (FHML), Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands.
Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
J Thorac Cardiovasc Surg. 2019 Apr;157(4):1567-1574. doi: 10.1016/j.jtcvs.2018.09.014. Epub 2018 Sep 29.
The aim of this study was to develop a high-fidelity minimally invasive mitral valve surgery (MIMVS) simulator.
The process of industrial serial design was applied based on pre-set requirements, acquired by interviewing experienced mitral surgeons. A thoracic torso with endoscopic and robotic access and disposable silicone mitral valve apparatus with a feedback system was developed. The feedback system was based on 4 cameras around the silicone valve and an edge detection algorithm to calculate suture depth and width. Validity of simulator measurements was assessed by comparing simulator-generated values with measurements done manually on 3-dimensional reconstructed micro-computed tomography scan of the same sutures. Independent surgeons tested the simulator between 2014 and 2018, whereupon an evaluation was done through a questionnaire.
The feedback system was able to provide width and depth measurements, which were subsequently scored by comparison to pre-set target values. Depth did not significantly differ between simulator and micro-computed tomography scan measurements (P = .139). Width differed significantly (P = .001), whereupon a significant regression equation was found (P < .0001) to calibrate the simulator. After calibration, no significant difference was found (P = .865). In total, 99 surgeons tested the simulator and more than agreed with the statements that the simulator is a good method for training MIMVS, and that the mitral valve and suture placement looked and felt realistic.
We successfully developed a high-fidelity MIMVS simulator for endoscopic and robotic approaches. The simulator provides a platform to train skills in an objective and reproducible manner. Future studies are needed to provide evidence for its application in training surgeons.
本研究旨在开发一种高保真微创二尖瓣手术（MIMVS）模拟器。
根据经验丰富的二尖瓣外科医生的访谈结果，采用工业串行设计过程，确定预设要求。设计了具有内窥镜和机器人通道的胸腔模型，以及带有反馈系统的一次性硅胶二尖瓣装置。该反馈系统基于硅胶阀周围的 4 个摄像头和边缘检测算法，用于计算缝线深度和宽度。通过将模拟器生成的值与相同缝线的三维重建微计算机断层扫描的手动测量值进行比较，评估模拟器测量值的有效性。
反馈系统能够提供宽度和深度测量值，然后通过与预设目标值进行比较来评分。深度测量值与模拟器和微计算机断层扫描测量值之间没有显著差异（P =.139）。宽度测量值有显著差异（P =.001），因此发现了一个显著的回归方程来校准模拟器（P <.0001）。校准后，差异不显著（P =.865）。共有 99 名外科医生测试了该模拟器，他们非常同意以下观点：模拟器是培训 MIMVS 的一种很好的方法，并且二尖瓣和缝线的放置看起来和感觉都很真实。
我们成功开发了一种用于内窥镜和机器人方法的高保真 MIMVS 模拟器。该模拟器提供了一个客观、可重复的技能培训平台。未来的研究需要提供证据，证明其在培训外科医生方面的应用。
