A hybrid, low-cost tissue-like epidural needle insertion simulator

Development and Validation of a Hybrid Nuss Procedure Surgical Simulator and Trainer

OBJECTIVE

This work presents the development and validation of an interactive simulation training platform for the minimally invasive repair of pectus excavatum, otherwise known as the Nuss procedure.

METHODS

The challenges and implications of developing both an all-virtual and an all-physical version of the simulator are investigated in a training context. A hybrid system is then developed that integrates virtual and physical constituents and a haptic interface to reproduce the primary steps of the procedure and to satisfy clinically relevant prerequisites for its training system. Furthermore, this work carries out a study to investigate the system's face, content, and construct validity.

RESULTS

Objective and subjective evaluations of the system demonstrate its utility for surgical training and establish various levels of its validity.

CONCLUSION

A hybrid virtual/physical configuration of the trainer can efficiently and realistically reproduce the primary steps of the procedure.

SIGNIFICANCE

Outside of this work, a simulation and training platform for the Nuss procedure is not available. This system was developed in close collaboration with the pioneers of this surgical technique.

3D anatomical model for teaching canine lumbosacral epidural anesthesia

Purpose

To develop a 3D anatomical model for teaching canine epidural anesthesia (3DMEA) and to assess its efficacy for teaching and learning prior to the use of live animals.

Methods

The creation of 3DMEA was based on 3D optical scanning and 3D printing of canine bone pieces of the fifth to the seventh lumbar vertebrae, sacrum and pelvis. A total of 20 male dogs were scheduled for castration. 20 veterinary students watched a video showing epidural anesthesia in dogs before the clinical attempt and were assigned to control or 3DMEA groups. Students in the 3DMEA group trained in the model after the video. For the clinical trial, the epidural procedure was performed by students under the veterinary supervision. When observed the absence of response to nociceptive stimuli, the epidural was considered successful. Then, all students answered a questionnaire evaluating the main difficulty founded in the technique and its degree of difficulty.

Results

The 3DMEA group reported a lower degree of difficulty to perform the epidural anesthesia technique when compared with the control group (p=0.0037). The 3DMEA reproduced the anatomical structures, allowing the perception of the distance of needle in relation to the iliac prominences during epidural anesthesia. Its mobility allowed simulation of the animal in standing position and sternal recumbency.

Conclusion

The use of 3DMEA demonstrated greater efficacy in the execution of the technique, being effective in the teaching and learning process before the epidural anesthesia in live animals.