A. J. Doud1, E. Roselli2, G. Loor1 1University Of Minnesota,Cadiothoracic Surgery,Minneapolis, MN, USA 2Cleveland Clinic,Cleveland, OH, USA
Introduction: Traditional methods of passing surgical expertise from mentor to student have relied on observation and graduated repetition of core component tasks, built together gradually into a broader surgical competency. While simulation in medical training has emerged as a supplemental alternative means of polishing surgical skill, ultimately time spent in the operating room with a surgical mentor is what knits together these skills into a meaningful body of applicable knowledge. However, direct contact with a surgical mentor is limited by availability, caseload and the educational needs of other students. Ideally, surgical mentorship would focus on the critical elements of a student’s deficits, offer timely feedback for improvement, and be readily available in a student’s down-time. Here we present an early-concept system for mentored surgical practice, which may be assembled with 3D-printable and off-the-shelf components. The system may be supported by a web-based video exchange system, which allows students to upload video of their surgical training from the home or training lab, receive critique from surgical mentors reviewing their videos remotely, and monitor their improvement over time.
Methods: Tasks included in the trainer are focused on cardiothoracic surgical practice. Stations present in the trainer include coronary anastomosis, mitral valve replacement, aortic valve repair, aortic grafting and cannulating. Dimensions of obstacle and barrier pieces were modified from prototype models produced from averaged CT anatomical data for difficult cases in each sub-competency of surgical practice. Vascular simulation material was constructed from a variety of fabrics selected for realism of feel when suturing. Attention was paid to approximating the spatial and tactile constraints of working within the mediastinum.
Results: All components of the cardiothoracic trainer were fabricated from either off-the-shelf components or 3D-printable components. These components were printed in PLA plastic using a Makerbot Replicator 2 printer. The machine was able to preserve the geometry of all components and produce a set of pieces needed for a trainer in under 10 hours of unsupervised machine time.
Conclusion: Previous prototypes of the surgical trainer required prohibitively costly large-scale fabrication methods to produce the parts needed for the trainer, which in its primary iteration obviated widespread resident use. We took a new approach in attempting to replicate the functionality of the prior prototype, while exchanging “off-the-shelf”, or small volume 3D-printed components for more costly machined or manufactured parts. Over 50% cost reduction per unit was achievable independent of production volumes . The next round of investigation will focus on in-home use of the system by surgical residents using a novel tele-mentoring system actively under development.