Flexible and comprehensive patient-specific mitral valve silicone models with chordae tendineae made from 3D-printable molds
Flexible and comprehensive patient-specific mitral valve silicone models with chordae tendineae made from 3D-printable molds
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DOI：
10.1007/s11548-019-01971-9
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发表时间：
2019-07-01
影响因子：
3
通讯作者：
De Simone, Raffaele
中科院分区：
文献类型：
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作者：
Engelhardt, Sandy;Sauerzapf, Simon;De Simone, Raffaele
目的考虑到外科医生在二尖瓣修复手术中面临的众多挑战，他们在进入手术室之前应该对器械的操作和手术技术的应用有很高的信心。不幸的是，微创修复手术培训的机会是非常有限的，导致大多数外科医生在操作第一patients.MethodsIn的同时经历陡峭的学习曲线的情况下，为了提供一个现实的工具，手术培训，一个商业模拟器增加了灵活的患者特定的二尖瓣复制品。在经过多次优化循环后最终完成的精心制作的生产管道中，模型从3D超声中分割出来，然后自动计算3D可打印模具，并用刚性材料打印，下部是水溶性的。硅胶注射后，硅胶模型从模具中溶解并锚定在模拟器中。结果据我们所知，我们的模型是第一个包含完整二尖瓣装置的模型，即，瓣环、瓣叶、腱索和乳头肌。根据拟定的工作流程自动创建了9个不同的瓣膜模具（7个脱垂瓣膜和2个功能性二尖瓣关闭不全瓣膜）。从这些模具的几何形状，16复制品制造。材料测试显示，Ecoflex（TM）00-30是七种混合物中最适合用于小叶模拟组织的材料。每个瓣膜的生产时间约为36小时。12名外科医生进行了各种手术技术，例如，瓣环成形术，新腱索植入，三角瓣叶切除术，并评估了现实主义的阀门非常positive.ConclusionThe标准化的生产过程保证了高度的解剖重演的硅胶阀分割模型和超声数据。模型具有前所未有的质量，并在与手术工具和缝线材料的触觉交互过程中保持高度真实感。
PurposeGiven the multitude of challenges surgeons face during mitral valve repair surgery, they should have a high confidence in handling of instruments and in the application of surgical techniques before they enter the operating room. Unfortunately, opportunities for surgical training of minimally invasive repair are very limited, leading to a situation where most surgeons undergo a steep learning curve while operating the first patients.MethodsIn order to provide a realistic tool for surgical training, a commercial simulator was augmented by flexible patient-specific mitral valve replica. In an elaborated production pipeline, finalized after many optimization cycles, models were segmented from 3D ultrasound and then 3D-printable molds were computed automatically and printed in rigid material, the lower part being water-soluble. After silicone injection, the silicone model was dissolved from the mold and anchored in the simulator.ResultsTo our knowledge, our models are the first to comprise the full mitral valve apparatus, i.e., the annulus, leaflets, chordae tendineae and papillary muscles. Nine different valve molds were automatically created according to the proposed workflow (seven prolapsed valves and two valves with functional mitral insufficiency). From these mold geometries, 16 replica were manufactured. A material test revealed that Ecoflex(TM)00-30 is the most suitable material for leaflet-mimicking tissue out of seven mixtures. Production time was around 36h per valve. Twelve surgeons performed various surgical techniques, e.g., annuloplasty, neo-chordae implantation, triangular leaflet resection, and assessed the realism of the valves very positively.ConclusionThe standardized production process guarantees a high anatomical recapitulation of the silicone valves to the segmented models and the ultrasound data. Models are of unprecedented quality and maintain a high realism during haptic interaction with instruments and suture material.