3D Printing Simulation Research Articles

Gathering validity evidence for a 3D-printed simulator for training of myringotomy and ventilation tube insertion.

This study aimed to gather validity evidence according to Messick's framework for a novel 3D-printed simulator for myringotomy with ventilation tube insertion for use in technical skills training of otorhinolaryngology (ORL) residents. The study included 15 junior ORL residents (trainees) and 13 experienced teaching otolaryngologists (experts). Experts and trainees first received an identically structured introduction to the procedure, simulator, and simulation setup. Five procedures performed by each participant were video-recorded and ordered randomly for blinded rating by two independent raters. The rating tools used were a global rating scale (GBRS) and a task-specific checklist. Validity evidence was collected according to Messick's framework. Differences in time consumption and performance scores were analyzed. Finally, a pass/fail standard was established using the contrasting groups' method. Trainees used significantly more time per procedure (109 s, 95% CI: 99-120) than experts (82 s, 95% CI: 71-93; p < .001). Adjusted for repetition and rater leniency, experts achieved an average GBRS score of 18.8 (95% CI: 18.3-19.2) out of 20 points, whereas trainees achieved an average of 17.1 points (95% CI: 16.6-17.5; p < .001). In contrast to the task-specific checklist, the GBRS score discriminated between repetition number and participant experience. The pass/fail standard for the GBRS was established at 18.4 points. We established educational validity evidence for a novel 3D-printed model for simulation-based training of ventilation tube insertion and established a reliable pass/fail standard. 1b.

Validation of a 3D-Printed Percutaneous Injection Laryngoplasty Simulator: A Randomized Controlled Trial.

Simulation may be a valuable tool in training laryngology office procedures on unsedated patients. However, no studies have examined whether existing awake procedure simulators improve trainee performance in laryngology. Our objective was to evaluate the transfer validity of a previously published 3D-printed laryngeal simulator in improving percutaneous injection laryngoplasty (PIL) competency compared with conventional educational materials with a single-blinded randomized controlled trial. Otolaryngology residents with fewer than 10 PIL procedures in their case logs were recruited. A pretraining survey was administered to participants to evaluate baseline procedure-specific knowledge and confidence. The participants underwent block randomization by postgraduate year to receive conventional educational materials either with or without additional training with a 3D-printed laryngeal simulator. Participants performed PIL on an anatomically distinct laryngeal model via trans-thyrohyoid and trans-cricothyroid approaches. Endoscopic and external performance recordings were de-identified and evaluated by two blinded laryngologists using an objective structured assessment of technical skill scale and PIL-specific checklist. Twenty residents completed testing. Baseline characteristics demonstrate no significant differences in confidence level or PIL experience between groups. Senior residents receiving simulator training had significantly better respect for tissue during the trans-thyrohyoid approach compared with control (p < 0.0005). There were no significant differences in performance for junior residents. In this first transfer validity study of a simulator for office awake procedure in laryngology, we found that a previously described low-cost, high-fidelity 3D-printed PIL simulator improved performance of PIL amongst senior otolaryngology residents, suggesting this accessible model may be a valuable educational adjunct for advanced trainees to practice PIL. NA Laryngoscope, 134:318-323, 2024.

Validating a 3D-Printed En7dovascular Simulator for Use in Training Surgical Residents

Endovascular simulators have become a standard in education for surgical residents. However, these products are expensive to purchase and maintain, limiting their accessibility. Endovascular models created using in-house 3D printing can be an affordable alternative but currently lack the rigorous validation needed to be a dependable educational tool. The purpose of this study is to determine the construct validity of a 3D-printed endovascular model of an aorta. A 3D rendering of an aorta was created using a patient computed tomography scan and subsequently printed on a Form B printer with transparent clear V4 resin (Fig 1). The pieces were combined to create a final product with a material cost of $50. Participants were asked to perform 2 tasks from a femoral access point: catheterizing the contralateral common iliac artery and cannulating the superior mesenteric artery (SMA). For each task, a 5-point rubric was created to assess whether all components of the tasks were done correctly. Participants were also assessed on the time taken to perform the tasks. Participants’ level of education (medical student vs surgical resident vs attending) and level of endovascular experience (<5 procedures = no experience, 6-100 = some experience, and >100 extensive experience) were noted. Of a total of 37 participants, 12 were medical students, 21 were residents, and 4 were attendings. A total of 26 participants had no experience, 6 had some experience, and 5 had extensive experience. Neither education level nor experience level had a significant bearing on whether either task was completed. Those with higher education completed the SMA task more accurately (P = .007), but this pattern was not observed for higher levels of experience. Univariate analysis shows that both higher education and greater experience resulted in faster times for both tasks, but multivariate analysis shows that only the level of experience was a predictor for faster completion (Fig 2, P = .02). This is reinforced by the finding that among participants with no experience, higher levels of education do not result in faster times (P = .16). These findings verify the construct validity of this endovascular simulator, as those with the most real-world experience completed the tasks the fastest. The observation that residents did more of the steps correctly than medical students may be because they have greater knowledge of endovascular procedures, but this did not translate to faster performance, which requires muscle memory. Basic 3D-printed endovascular models should therefore be strongly considered as an affordable, readily accessible adjunct to surgical resident education.Fig 2Combined time, in seconds, for participants with no experience, some experience, and extensive experience to complete the catheterization of the contralateral common iliac artery and superior mesenteric artery (SMA). Error bars show 95% confidence interval (CI). Increasing real-world endovascular experience trends with decreased completion times, with statistical significance (P < .05) achieved between the “no experience” and “extensive experience” groups, denoted by *.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Hand Sewn Anastomosis Skill Acquisition and In Vivo Transfer Using 3D-Printed Small Bowel Simulator

IntroductionGeneral surgery residents need to master the hand-sewn bowel anastomosis (HSBA) technique. However, practice opportunities outside of the operating room are rare, and commercial simulators are often costly. The objective of this study is to assess the efficacy of a new, affordable silicone small bowel simulator, made with a three-dimensional (3D) printed mold, as a training tool to learn this technique. MethodsThis was a single-blinded pilot randomized controlled trial comparing two groups of eight junior surgical residents. All participants completed a pretest using an inexpensive, custom developed 3D-printed simulator. Next, participants randomized to the experimental group practiced the HSBA skill at home (eight sessions), while those randomized to the control group did not receive any hands-on practice opportunities. A posttest was done using the same simulator as for the pretest and practice sessions, and the retention-transfer test was performed on an anesthetized porcine model. Pretests, posttests and retention-transfer tests were filmed and graded by a blinded evaluator using assessments of technical skills, quality of final product, and tests of procedural knowledge. ResultsThe experimental group significantly improved after practicing with the model (P = 0.01), while an equivalent improvement was not noted in the control group (P = 0.07). Moreover, the experimental group's performance remained stable between the posttest and the retention-transfer test (P = 0.95). ConclusionsOur 3D-printed simulator is an affordable and efficacious tool to teach residents the HSBA technique. It allows development of surgical skills that are transferable to an in vivo model.

The RAKT Box: A novel, entirely 3D-printed hyper-accuracy simulator for vascular anastomoses during robot-assisted kidney transplantation

The RAKT Box: A novel, entirely 3D-printed hyper-accuracy simulator for vascular anastomoses during robot-assisted kidney transplantation

3D printing integrated with multimodality imaging for planning periprosthetic leak closures

Percutaneous closure of the paravalvular leak (PVLc) has emerged as a palliative alternative to surgical management in selected cases. A multimodal imaging analysis before and during the procedure is mandatory to choose the better device based on anatomical factors. However, it remains challenging in achieving complete leak occlusion, while respecting prosthesis function. 3D printed models have emerged as a useful tool to assist complex cardiac interventions. To explore the additional value of 3D printing integrated with multimodality imaging in predicting complications including mechanical valve leaflets blockade, device embolization, residual shunt. We selected 11 PVLc procedures from 3 centers in which 3D printed model were used prior to the procedure from the prospective FFPP registry between 2017 and 2019 (NCT05089136). Cardiac CT was used for segmentation for 3D printed (3D-heart modeling, Caissargues, France). Technology used a laser to fuse very fine powders [thermoplastic polyurethane (TPU)] into a final part – laser sintering technology (SLS) with an adapted elasticity. A simulation on 3D printed model was performed before the procedure. Four PVLc mitral prostheses (3 mechanical). Six aortic: 2 biological, 2 suturesless, 2 mechanical. One PVLC post-tricuspid annuloplasty (Fig. 1). The device chosen on 3D model matched with in situ one in 8/11 cases without residual leakage. A risk of prosthesis blocage was detected in 5 cases. In one patient the plug was not implanted, in another the plug was removed, in another case the orientation of the plug was optimally adapted according to the simulation while in 2 patients, the plug-induced blockage detected during the 3D printing simulation occurred delayed after the procedure when the loading conditions changed. 3D printing can be integrated into the multimodal planning of PVLc procedures. It improves the detection of the risk of complications such as leaflet blockage or residual leakage through a direct study of the interaction between the devices and the prosthesis, taking into account the deformations of both the devices and the surrounding structures.

C-CASE 2022: Competence to Excellence01. The Queen Bee phenomenon in Canadian surgical subspecialties: an evaluation of gender biases in the resident training environment02. Barriers to surgical peer coaching — What have we learned, and where do we go from here?03. Shared decision-making and evidence-based medicine: Pivotal or trivial to patient care in orthopedic trauma?04. Immersive virtual reality and cadaveric bone

# 01. The Queen Bee phenomenon in Canadian surgical subspecialties: an evaluation of gender biases in the resident training environment {#article-title-2} The Queen Bee phenomenon describes the behavioural response that occurs when women achieve success in a male-dominated environment, and in this

Abstract 11145: Biomechanical Engineering Analysis of Leaflet Kinematics and Native Coronary Flow After Valve-Sparing Aortic Root Replacement Using Four Graft Configurations

Introduction: Different ex vivo root biomechanics after valve-sparing aortic root replacement (VSARR) using several graft configurations have been described. The impact of graft choice on each cusp’s kinematics and native coronary flow remains unclear. The objective was to analyze valve kinematics and coronary flow after VSARR using 4 graft configurations in a 3D-printed heart simulator ( Fig A ).[YZ1] Methods: Porcine aortic roots with coronary arteries were explanted (n = 5). Native roots served as controls ( Fig B ). Each sample underwent VSARR using straight graft (SG), Valsalva graft (VG), anti-commissural plication (ACP), and Stanford modification (SMOD) in a random order ( Fig C-G ). Hemodynamics and videometric data were analyzed ( Fig H, I ). Results: SG showed the lowest regurgitant fraction (2.8 ± 1.5 %) compared to control (6.3 ± 3.9 %, p = .0002), VG (12.2 ± 3.6 %, p = .002), ACP (12.9 ± 1.3 %, p = .001), and SMOD (12.2 ± 3.0 %, p = .001, Fig J, K ). The left coronary artery flow was higher in SG (0.68 ± 0.16 L/min) compared to VG (0.55 ± 0.22 L/min, p = 0.05) and SMOD (0.51 ± 0.23 L/min, p = 0.05, Fig L ). The right coronary artery flow was higher in SG (0.20 ± 0.10 L/min) compared to VG (0.07 ± 0.04 L/min, p = 0.04) and SMOD (0.08 ± 0.05 L/min, p = 0.04, Fig M ). SG (26.5 ± 17.6 cm/s) compared to VG (48.3 ± 19.0 cm/s, p = .001) and SMOD (39.5 ± 10.1 cm/s, p = .05) showed lower rapid opening velocity in the left coronary cusp (LCC). SG (8.1 ± 6.2 cm/s) compared to VG (15.0 ± 10.6 cm/s, p = .04) showed lower rapid closing velocity in the right coronary cusp. The VG (17.7 ± 9.7 Hz) had higher flutter frequency in the LCC compared to control (11.9 ± 4.1 Hz, p = .02). The SG (11.9 ± 4.5 dB/Hz) compared to ACP (16.4 ± 4.7 dB/Hz, p = .01) showed lower flutter power in the LCC. Conclusions: Compared to other configurations, SG had the most optimal hemodynamics, native coronary flow, and leaflet kinematics. Further in vivo validation studies should be performed to evaluate flow dynamics in the root and assess for clinical applicability.

Efficacy of 3D-printed simulation models of unruptured intracranial aneurysms in patient education and surgical simulation.

The purpose of this study was to determine the efficacy of a 3D-printed aneurysm simulation model (3DPM) in educating patients and improving physicians' comprehension and performance. This prospective study involved 40 patients who were diagnosed with unruptured intracranial aneurysms (UIAs) and scheduled for surgical clipping or endovascular coiling and randomly divided into two groups (the 3DPM group and the non-3DPM group). The 3DPM was used in preoperative consultation with patients and intraoperatively referenced by surgeons. The patients, 7 neurosurgical residents, and 10 surgeons completed questionnaires (5-point Likert scale) to determine the usefulness of the 3DPM. Patients in the 3DPM group had significantly higher scores in terms of their understanding of the disease (mean 4.85 vs. 3.95, p<0.001) and the treatment plan (mean 4.85 vs. 4.20, p=0.005) and reported higher satisfaction during consultation (5.0 vs. 4.60, p=0.036) than patients in the non-3DPM group. During patient consultation, 3DPMs were most useful in improving doctor-patient communication (mean 4.57, range 4-5). During clipping surgery, the models were most useful in assessing adjacent arteries (mean 4.9, range 4-5); during endovascular coiling, they were especially helpful in microcatheter shaping (mean 4.7, range 4-5). In general, 3DPMs are beneficial in educating patients and improving the physician's performance in terms of surgical clipping and endovascular coiling of UIAs.

Design, Development and Multi-Institutional Validation of a Low-Cost 3D-Printed Liver Transplant Simulator

Objective: Our team set out to design and develop a low-cost 3D-printed liver transplant simulator. Design: The simulator comprises a 3D-printed recipient body cavity and the filled-fabric liver. Results: Validators perceived the model as valuable to education, noted that they would use the model at their institution and desired to integrate the model into their curriculum. In addition, the simulator was rated highly for ease of use (3.6/4), physical attributes (3.2/4) and user experience (4.4/5). Conclusion: The low-cost 3D-printed simulator for liver transplantation was highly rated in a multi-institutional validation and supports the use of simulation models in transplant surgery.

Effect of Implant Positions and Angulations on Retentive Strength of 2-Implant Mandibular Overdentures: An In Vitro Study with the New 3D-Printed Simulation Method

Objectives To evaluate the retentive strength of overdenture attachments in 2-implant mandibular overdenture (2IMO) with implants placed at different positions and angulations. Materials and Methods Edentulous mandibular models were 3D-printed using CBCT images and Materialise Mimics software and the denture models using the intraoral scanner. Two standard implants were placed parallel at different positions from midline (5, 10, 15, and 20 mm) with 0-0 degree angulations and with different distal angulations (0–5, 0–10, 0–15, 5-5, 10-10, and 15-15 degrees) at 10±mm from midline representing 10 study groups. Low-profile male attachments were attached to the implants and the female pink attachments were picked up in the denture. A total of 4 simulated overdenture model sets for each of the 10 study groups were subjected to the universal testing machine thrice to measure a peak load (N) to disengage the attachments vertically. Data were analyzed using one-way ANOVA and Tukey's post hoc test at 0.05 significance level. Results Varying implant positions had a statistically significant effect on the retentive strengths of the attachments (F = 5.61, P = 0.002). Peak load-to-dislodgement values (in increasing order) were 49.64 ± 8.27 N for 5 mm, 53.26 ± 11.48 N for 10 mm, 60.24 ± 12.31 N for 15 mm, and 64.80 ± 6.78 N for 20 mm groups. The retentive strength of the 20 mm group was significantly higher than 5 mm (P = 0.003) and 10 mm (P = 0.03) groups. Varying implant angulations had a significant effect on the retentive strengths of the attachments (F = 7.412, P = 0.000). The peak load-to-dislodgement values (in increasing order) were 48.20 ± 15.59 N for 5-5 degrees, 53.26 ± 11.48 N for 0-0 degrees, 54.96 ± 8.25 N for 0–5 degrees, 57.71 ± 7.62 N for 10-10 degrees, 66.00 ± 17.54 N for 15-15 degrees, 66.18 ± 14.09 N for 0–10 degrees, and 77.38 ± 10.33 N for 0–15 degrees. Retentive strength of 0–15 degrees was significantly (P < 0.05) higher than those of 0-0, 0–5, 5-5, and 10-10 degrees and that of 5-5 degrees was significantly (P < 0.05) lower than those of 0–10, 0–15, and 15-15 groups. Conclusions Retentive strength of the 2IMO increased with increase in distance of implants from midline and increased with increase in distal angulations.

The Development and Initial End-Point User Feedback of a 3D-Printed Adult Proximal Tibia IO Simulator.

Intraosseous infusion (IO) remains an underutilized technique for obtaining vascular access in adults, despite its potentially life-saving benefits in trauma patients. In rural and remote areas, shortage of training equipment and human capacity (i.e., simulators) are the main contributors to the shortage of local training courses aiming at the development and maintenance of IO skills. Specifically, current training equipment options available for trainees include commercially available simulators, which are often expensive, or animal tissues, which lack human anatomical features that are necessary for optimal learning and pose logistical and ethical issues related to practice on live animals. Three-dimensional (3D) printing provides the means to create cost-effective, anatomically correct simulators for practicing IO where existing simulators may be difficult to access, especially in remote areas. This technical report aims to describe the development of maxSIMIO, a 3D-printed adult proximal tibia IO simulator, and present feedback on the design features from a clinical co-design team consisting of 18 end-point users. Overall, the majority of the feedback was positive and highlighted that the maxSIMIO simulator was helpful for learning and developing the IO technique. The majority of the clinical team responders also agreed that the simulator was more anatomically accurate compared to other simulators they have used in the past. Finally, the survey results indicated that on average, the simulator is acceptable as a training tool. Notable suggestions for improvement included increasing the stability of the individual parts of the model (such as tightening the skin and securing the bones), enhancing the anatomical accuracy of the experience (such as adding a fibula), making the bones harder, increasing the size of the patella, making it more modular (to minimize costs related to maintenance), and improving the anatomical positioning of the knee joint (i.e., slightly bent in the knee joint). In summary, the clinical team, located in rural and remote areas in Canada, found the 3D-printed simulator to be a functional tool for practicing the intraosseous technique. The outcome of this report supports the use of this cost-effective simulator for simulation-based medical education for remote and rural areas anywhere in the world.

Virtual-Augmented Reality and Life-Like Neurosurgical Simulator for Training: First Evaluation of a Hands-On Experience for Residents.

BackgroundIn the recent years, growing interest in simulation-based surgical education has led to various practical alternatives for medical training. More recently, courses based on virtual reality (VR) and three-dimensional (3D)-printed models are available. In this paper, a hybrid (virtual and physical) neurosurgical simulator has been validated, equipped with augmented reality (AR) capabilities that can be used repeatedly to increase familiarity and improve the technical skills in human brain anatomy and neurosurgical approaches.MethodsThe neurosurgical simulator used in this study (UpSurgeOn Box, UpSurgeOn Srl, Assago, Milan) combines a virtual component and a physical component with an intermediate step to provide a hybrid solution. A first reported and evaluated practical experience on the anatomical 3D-printed model has been conducted with a total of 30 residents in neurosurgery. The residents had the possibility to choose a specific approach, focus on the correct patient positioning, and go over the chosen approach step-by-step, interacting with the model through AR application. Next, each practical surgical step on the 3D model was timed and qualitatively evaluated by 3 senior neurosurgeons. Quality and usability-grade surveys were filled out by participants.ResultsMore than 89% of the residents assessed that the application and the AR simulator were very helpful in improving the orientation skills during neurosurgical approaches. Indeed, 89.3% of participants found brain and skull anatomy highly realistic during their tasks. Moreover, workshop exercises were considered useful in increasing the competency and technical skills required in the operating room by 85.8 and 84.7% of residents, respectively. Data collected confirmed that the anatomical model and its application were intuitive, well-integrated, and easy to use.ConclusionThe hybrid AR and 3D-printed neurosurgical simulator could be a valid tool for neurosurgical training, capable of enhancing personal technical skills and competence. In addition, it could be easy to imagine how patient safety would increase and healthcare costs would be reduced, even if more studies are needed to investigate these aspects. The integration of simulators for training in neurosurgery as preparatory steps for the operating room should be recommended and further investigated given their huge potential.

A novel arthroscopy training program based on a 3D printed simulator

BackgroundArthroscopy is the most important and exciting contribution to sports medicine of the last 100 years. One of its main limitations, however, is the steep learning curve it requires, which is not easy to beat given the scarcity and the high price of arthroscopy simulators. Hypothesis/purposeTo describe and evaluate the effectiveness of an open-access arthroscopy training program based on a 3D-printed simulator. MethodsA model was designed, which was to be printed on a fused filament fabrication (FFF) 3D printer for home use with polylactic acid (PLA) filaments. Fourteen exercises were prepared, each with its timeframe and conceptual goals, arranged from least difficult to most challenging. Exercises were designed to assist subjects in developing the skills of an experienced arthroscopic surgeon through use of the simulator. Twenty subjects from nine hospitals completed the arthroscopy training program. Performance in each exercise was evaluated according to the Arthroscopic Surgical Skill Evaluation Tool (ASSET), taking into account the number of times a student had to repeat each exercise to complete it successfully. ResultsThe mean ASSET score for each exercise was 22 points (IQR 19–25) and the mean number of times students had to repeat each exercise was 16 (95% CI 15.27–17.97). Eighty-five percent of subjects completed the program. The device was printed without difficulty by an independent investigator without prior knowledge of 3D printing. The price of the device was under US$ 12. ConclusionSubjects exhibited an improvement in their basic arthroscopic skills on the simulator. The number of times each of them had to repeat each exercise was similar, which is indicative of a smooth progression of difficulty along the program. The device proved easy to print, accessible, economical, and effective. This is the first structured program based on an open-access arthroscopic simulator to obtain satisfactory results.

Experimental Investigation of Blood Mimicking Fluid Viscosity for Application in 3D-Printed Medical Simulator

Blood mimicking fluid (BMF) is blood that accurately mimics human blood. BMF is commonly used in 3D printed medical simulators for pre-surgical planning and simulation or intraoperative orientation to assist surgeons on cardiac surgical procedures. This research aims to develop a newly formulated BMF containing polysaccharide particles via varying the percent composition of xanthan gum-starch-water-glycerol-contrast agent mixture. The viscosity of the formulated BMF is compared with human blood and observed. A total of 10 BMF samples consisting of different components and composition ratios is prepared and the viscosity of each sample is measured at shear rates ranging from 0s−1 to 1000s−1. The results are tabulated and compared with human blood. Based on the results of the experiments conducted, the addition of polysaccharide particles was found to affect the viscosity of the BMF. The BMF sample with a composition of water 59.98 vol%, glycerol 40 vol%, 0.01 wt% xanthan gum and 0.01 wt% starch shows the smallest viscosity percentage difference when compared to the viscosity of actual blood. Viscosity plateau values was found at 3.71± 0.34 mPa.s which is within the range of actual normal human whole blood viscosity.

A low-cost otoscopy simulator increased confidence in mechanical otoscopy skills and tympanic membrane pathology identification among preclinical medical students during the COVID-19 pandemic

Background: Diagnostic evaluation of otologic diseases often requires otoscopy to visualize the tympanic membrane. The fundamentals of otoscopy include both learning the mechanics of using an otoscope and accurately identifying ear pathologies. During the COVID-19 pandemic, there was limited peer-to-peer physical exam practice for preclinical medical students. We developed a low-cost 3D-printed otoscopy simulator to teach the otoscopic exam to small groups of medical students. Methods: A modified open-source 3-dimensional (3D) head was printed, and a silicone ear was attached. A user interface was created to display one normal tympanic membrane and four pathologies. Preclinical medical students attended a didactic lecture on common otologic pathologies and on how to perform otoscopy. Students then practiced otoscopy and pathology identification on the simulator in small groups. After the session, students were provided an optional survey to evaluate their confidence in otoscopy skills and pathology identification. Results: A total of 47 out of 134 (35%) medical students completed the survey, of whom 60% reported that training with the 3D printed otoscopy simulator was at least moderately effective in learning the mechanical techniques of otoscopy, and 66% found the simulator to be at least moderately effective in helping them learn to identify pathology. The majority (57%) of students reported that the otoscopy simulator was more effective than practicing otoscopy on their peers. Conclusions: We demonstrate the utility of a novel low-cost 3D printed otoscopy simulator to teach both the mechanical skills and pathology identification necessary in performing an otoscopic exam to preclinical medical students.

Improving Nasopharyngeal Swab Technique via Simulation for Frontline Workers.

Objectives/HypothesisNasopharyngeal swabs currently remain the gold standard for COVID‐19 sample collection. A surge in testing volume has resulted in a large number of health care workers who are unfamiliar with nasal anatomy performing this test, which can lead to improper collection practices culminating in false‐negative results and complications. Therefore, we aimed to assess the accuracy and educational potential of a realistic 3D‐printed nasal swab simulator to expedite health care workers' skill acquisition.Study DesignProspective pre‐post interventional study.MethodsA nasal swab task trainer (NSTT) was developed to scale from computed tomography data with a deviated septum. Frontline workers at COVID‐19 testing sites in Ontario, Canada, were recruited to use the NSTT for nasopharyngeal swab training. Integrated video recording capability allowed participants to self‐evaluate procedure accuracy. A five‐point Likert scale was collected regarding the NSTT's educational value and procedural fidelity.ResultsSixty‐two frontline workers included in the study were primarily registered nurses (52%) or paramedics (16%). Following simulator use, self‐assessed accuracy improved in 77% of all participants and 100% of participants who expressed low confidence before training. Ninety‐four percent reported that the NSTT provided a complete educational experience, and 82% regarded the system as a more effective training approach than what is currently available. Eighty‐one indicated that the simulator should be used at all COVID‐19 testing sites, with 77% stating province‐wide implementation was warranted.ConclusionsThe nasal swab task trainer is an effective educational tool that appears well‐suited for improved skill acquisition in COVID‐19 testing and may be useful for training other nasal swab applications.Level of Evidence3 Laryngoscope, 2022

Biomechanical engineering analysis of an acute papillary muscle rupture disease model using an innovative 3D-printed left heart simulator.

OBJECTIVESThe severity of acute papillary muscle (PM) rupture varies according to the extent and site of the rupture. However, the haemodynamic effects of different rupture variations are still poorly understood. Using a novel ex vivo model, we sought to study acute PM rupture to improve clinical management.METHODSUsing porcine mitral valves (n = 32) mounted within an ex vivo left heart simulator, PM rupture was simulated. The mitral valve was divided into quadrants for analysis according to the PM heads. Acute PM rupture was simulated by incrementally cutting from 1/3 to the total number of chordae arising from 1 PM head of interest. Haemodynamic parameters were measured.RESULTSRupture >2/3 of the chordae from 1 given PM head or regurgitation fraction >60% led to markedly deteriorated haemodynamics. Rupture at the anterolateral PM had a stronger negative effect on haemodynamics than rupture at the posteromedial PM. Rupture occurring at the anterior head of the anterolateral PM led to more marked haemodynamic instability than rupture occurring at the other PM heads.CONCLUSIONSThe haemodynamic effects of acute PM rupture vary considerably according to the site and extent of the rupture. Rupture of ≤2/3 of chordae from 1 PM head or rupture at the posteromedial PM lead to less marked haemodynamics effects, suggesting a higher likelihood of tolerating surgery. Rupture at the anterolateral PM, specifically the anterior head, rupture of >2/3 of chordae from 1 PM head or regurgitation fraction >60% led to marked haemodynamic instability, suggesting the potential benefit from bridging strategies prior to surgery.

Coronary protection for the small left coronary sinus during transcatheter aortic valve replacement: a case report

BackgroundCoronary obstruction (CO) is an infrequent but life-threatening complication during transcatheter aortic valve replacement (TAVR).Case summaryWe report the case of a patient who accepted TAVR with high anatomical risks of CO due to the small congenital left coronary sinus, which was treated with preliminary coronary protection. This case highlighted the importance of computed tomography angiography (CTA) evaluation, 3D-printing stimulation, predilation as a reference sign, and pre-emptive chimney stenting technology to successfully anticipate and prevent CO during TAVR. At the 3rd month follow-up, CTA evaluation and 3D-printing simulation identified the chimney stenting of the left main coronary arterial patency.DiscussionA ‘four-step assessment’ method also proposes a new clinical procedure on how to perform TAVR in patients with high risks of CO.

Anatomical Evaluation of Rat and Mouse Simulators for Laboratory Animal Science Courses.

Simple SummaryOver the past decades simulators of rats and mice have been developed as initial training devices for prospective researchers involved in animal testing. By using these simulators, different techniques such as blood sampling can be be learned prior to working on live animals. As this has the potential to minimize stress and suffering of experimental animals, the use of simulators is demanded by European law. Nevertheless, only little is known about frequency of their use, their anatomical correctness and learning efficiency. With this in mind, a collaborative research project named “SimulRATor” was initiated to systematically evaluate existing rat and mouse simulators. Results will serve as the basis for the development of a new 3D-printed rat simulator with realistic anatomy. In the subproject presented here, simulators were evaluated by experts of the field in order to analyze their anatomical strengths and weaknesses. The evaluation showed, that the limbs and especially the heads were perceived as anatomically unrealistic. Therefore, the authors will focus on these body regions during the construction process by e.g. including movable limbs, and a lower jaw with a tongue. This might positively affect the learning process and outcome and thereby support animal welfare.According to the European Directive 63/2010/EU, education and training involving living rats and mice are classified as an animal experiment and demands the implementation of the 3Rs. Therefore, as a method of refinement, rat and mouse simulators were developed to serve as an initial training device for various techniques, prior to working on living animals. Nevertheless, little is known about the implementation, anatomical correctness, learning efficiency and practical suitability of these simulators. With this in mind, a collaborative research project called “SimulRATor” was initiated to systematically evaluate the existing rat and mouse simulators in a multi-perspective approach. The objective of the study presented here was to identify the anatomical strengths and weaknesses of the available rat and mouse simulators and to determine anatomical requirements for a new anatomically correct rat simulator, specifically adapted to the needs of Laboratory Animal Science (LAS) training courses. Consequently, experts of Veterinary Anatomy and LAS evaluated the anatomy of all currently available rat and mouse simulators. The evaluation showed that compared to the anatomy of living rats and mice, the tails were perceived as the most anatomically realistic body part, followed by the general exterior and the limbs. The heads were rated as the least favored body part.