We have read with great interest the paper by Verberkmoes and Verberkmoes-Broeders [1]. They aimed to develop a low-fidelity, reusable and portable simulation device, which could provide training in nearly the full range of mitral valve surgery techniques. It is so important to achieve this kind of device with low cost for skill acquisition especially for residents. Because of its portability, it can be used in every place and at any time and provides advantage for the residents who have little time to make practice. After the widespread acceptance of minimally invasive approaches for mitral valve repair surgery which requires expertise, the importance of training models has become more evident. [2] In this era, we believe that such training models would be beneficial especially for young surgeons. In this valuable report, there is a particular topic we would like to discuss.
While there are many reports in literature advocating the advantages of simulation models, few model for mitral valve repair surgery are available. The reported model may optimize learning and result in skill acquisition. Establishing various pathological conditions in this model, according to Carpentier's Functional Classification, makes this model preferable. Gauging maximum mean suture tensions on the silicone teat and dental dam is also a good guiding mark for the surgeons to train on adjusting suture tensions.
Although the authors aimed to construct a ‘low fidelity model’ reflecting real-life experience for the 'operating room' (model fidelity) [3], and it is sufficient for motor learning, the major issue to be discussed in this model is the problem of a limited feedback, since we do not receive positive or negative feedback after each practice [1] as with the first version of our simulator [4]. Therefore, we have added a pressure system to our model to test each practice under static pressure. In conclusion, although this model has the advantage of low-fidelity and low cost, and can be used on numerous techniques, a tool or mechanism to provide feedback may be helpful for the trainees. For example, Greenhause at al. [5] performed a test to assess the effectiveness of their model, thereby revealing how useful the model was and what the surgeons took home.
Conflict of interest: none declared
References
- 1.Verberkmoes NJ, Verberkmoes-Broeders EM. A novel low-fidelity simulator for both mitral valve and tricuspid valve surgery: the surgical skills trainer for classic open- and minimally invasive techniques. Interact CardioVasc Thorac Surg. 2012 doi: 10.1093/icvts/ivs451. doi:10.1093/icvts/ivs451. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.Murzi M, Kallushi E, Tiwari KK, Cerillo AG, Bevilacqua S, Karimov JH, et al. Minimally invasive mitral valve surgery through right thoracotomy in patients with patent coronary artery bypass grafts. Interact CardioVasc Thorac Surg. 2009;9:29–32. doi: 10.1510/icvts.2009.203745. [DOI] [PubMed] [Google Scholar]
- 3.Sidhu RS, Park J, Brydges R, MacRae HM, Dubrowski A. Laboratory-based vascular anastomosis training: a randomized controlled trial evaluating theeffects of bench model fidelity and level of training on skill acquisition. J Vasc Surg. 2007;45:343–9. doi: 10.1016/j.jvs.2006.09.040. [DOI] [PubMed] [Google Scholar]
- 4.Tavlasoglu M, Jahollari A, Amrahov A, Sahin MA. An instrument facilitates mitral valve repair training at home. Eur J Cardiothorac Surg. 2012;41:940–41. doi: 10.1093/ejcts/ezr087. [DOI] [PubMed] [Google Scholar]
- 5.Greenhouse DG, Jr, Grossi EA, Dellis S, Park J, Yaffee DW, Deanda A, Jr, et al. Assessment of a mitral valve replacement skills trainer: A simplified, low-cost approach. J Thorac Cardiovasc Surg. 2012 doi: 10.1016/j.jtcvs.2012.09.074. doi:10.1016/j.jtcvs.2012.09.074. [DOI] [PubMed] [Google Scholar]