title: A novel low-fidelity simulator for both mitral valve and tricuspid valve surgery: the surgical skills trainer for classic open and minimally invasive techniques.
abstract: OBJECTIVE
  Simulators have been proven to equip trainee surgeons with better skills than the traditional, standard approach to skill development. The purpose of this study was to develop a low-fidelity, low-cost, reusable and portable simulation device, which could provide training in nearly the full range of mitral valve surgery techniques, in both the classic, open approach as well as the minimally invasive approach.
  
  
  METHODS
  This novel simulator is made up of commonly available components. The basic elements are a classic baby bottle, with the associated feeding teat and screw ring, in combination with a sheet of dental dam. The detailed process for making this simulator is outlined in this article. Maximum suture tensile strength on the different components was tested with a digital force gauge. Reusability and the rate of wear as a result of suturing were documented. Total cost was calculated in euros (€).
  
  
  RESULTS
  This study resulted in a simulation model very similar in size to the actual anatomical dimensions of the mitral valve. Various pathological conditions, according to Carpentier's Functional Classification, could be simulated. This led to the possibility of providing training in several mitral valve surgical techniques. As the model developed, it became clear that it could also be used to practice tricuspid valve surgery techniques. Maximum mean suture tensions on the silicone teat and dental dam were 42.11 and 11.15 N/m(2), respectively. The feeding teat started wearing after approximately 45 suture placements. Total cost of the study model was €5.14.
  
  
  CONCLUSIONS
  This relatively simple, low-cost, low-fidelity model can provide simulation training in nearly the full range of mitral valve and tricuspid valve surgical techniques, in both the classic open approach and the minimally invasive approach-and do so almost anywhere. Especially when used by young cardiothoracic surgeons in training, this model may contribute to the development of technical skills and procedural knowledge required for adequate performance in the operating room.
authors.affiliation: Department of Cardio-Thoracic Surgery, Catharina Hospital, Eindhoven, Netherlands. niels.verberkmoes@catharina-ziekenhuis.nl
authors.forename: Niels J
authors.initials: NJ
authors.lastname: Verberkmoes
authors.forename: Elizabeth M P C
authors.initials: EM
authors.lastname: Verberkmoes-Broeders
mesh_terms: D006348:Cardiac Surgical Procedures / Q000193:education*; D002983:Clinical Competence; D003362:Cost-Benefit Analysis; D004503:Education, Medical, Graduate / Q000191:economics / Q000379:methods*; D006349:Heart Valve Diseases / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008943:Mitral Valve / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D008953:Models, Anatomic; D008955:Models, Cardiovascular; D009048:Motor Skills; D013536:Suture Techniques / Q000193:education; D013663:Teaching / Q000191:economics / Q000379:methods*; D014261:Tricuspid Valve / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*