Date Published: June 1, 2020
Publisher: Springer International Publishing
Author(s): Brandon Peel, Pascal Voyer-Nguyen, Osami Honjo, Shi-Joon Yoo, Nabil Hussein.
The Hands-On Surgical Training in Congenital Heart Surgery (HOST-CHS) program using 3D printed heart models has received positive feedback from attendees. However, improvements were necessary in the simulator set up to replicate the ergonomics experienced in the operating room. This paper illustrates the development of a dynamic chest wall and operating table simulator to enhance the simulation experience.
The simulator was designed to address the limitations with the existing set up. This included a suboptimal operating position, unrealistic surgical exposure and limitations in illuminating the operative field and recording procedures. A combination of computer-aided design and various 3D-printing techniques were used to build the components. The simulator’s usefulness was evaluated by surgeons who attended the 5th annual HOST course via a questionnaire.
The simulator consists of three components; an operating table simulator which allows height adjustment and pitch-and-roll motion; a suture retraction disc, which holds sutures under tension to improve exposure; and a pediatric chest wall cavity to replicate a surgeon’s access experience during surgery. Nineteen surgeons completed the questionnaire. All surgeons agreed that the addition of the simulator was acceptable for surgical simulation and that it helped replicate the ergonomics experienced in the operating room.
The inclusion of the HOST-CHS simulator adds value to simulation in congenital heart surgery (CHS) as it replicates the view and exposure a surgeon experiences. Improvements like these will help develop high-fidelity simulation programs in CHS, which could be utilized to train surgeons globally.
Simulation is emerging as a tool to compliment surgical training and skill acquisition in congenital heart surgery (CHS), however its widespread use is limited [1–5]. The Hands-On Surgical Training in Congenital Heart Surgery (HOST-CHS) program uses 3D-printed heart models to simulate the technically complex operations required to treat congenital heart diseases. Despite the positive feedback from attendee surgeons improvements were necessary in the simulator set up to replicate the ergonomics experienced in the operating room [1, 2].
With the growing expectation of perfect patient outcomes, there is a need for improved training methods by implementing simulation in CHS . By producing a simulator that can be used in any environment, surgeons are able to rehearse technically challenging procedures in inconsequential environments. Simulators have been shown to be effective in training and have been successfully incorporated into national training programs in adult cardiothoracic surgery [6–8]. However, within CHS there is a clear gap in simulation, where one could argue the need is greater due to the high stakes involved and the complexity/limitation of cases .
With the increasing trend towards minimally invasive surgery, simulators will be required to validate and improve methods prior to real-life surgery. Within our institution, we are developing a chest wall simulator designed specifically for minimally-invasive congenital heart surgery (Fig. 5). This simulator will allow staff surgeons to rehearse operations and teach new techniques, which will be increasingly difficult to do in reality. Current limitations in the 3D-printing techniques and materials limits the inclusion of flow circuits with 3D-printed heart models, however there have been attempts to overcome this making it a tangible reality . It is expected that with the ongoing improvements in print materials, this is the next step in simulation.
Fig. 5Computer render of a minimally invasive dynamic chest wall and operating table simulator. Note the absence of a median sternotomy incision and the inclusion of a mini-thoracotomy incision the surgeon will operate through. The opposite side of the chest is removed to allow the teacher to observe the performance of the surgeon
The inclusion of the HOST-CHS simulator adds value to simulation in congenital heart surgery as it replicates the view and exposure a surgeon experiences. With training limitations being a global problem for congenital heart surgeons it is expected that simulators like these will be increasingly utilized in surgical training.