OC14.08: 3D ultrasound‐based patient‐matched models for surgical rehearsal of fetoscopic myelomeningocele repair
Year: 2018
Type: conference-abstract
Abstract: Evaluate surgical rehearsal and operative times for 2-port fetoscopic myelomeningocele (fMMC) repair in a newly established program. A simulator emulating a 22-26 weeks uterus was utilised for surgical rehearsal of fMMC repair using a 2-port approach. 3D printed models derived from 3D ultrasound volumes were used for each simulation session. Ability and time to complete key surgical steps (placode dissection, mattress suture placement with extracorporeal sliding knot) was ascertained. Surgical outcomes were compared between simulated and actual surgeries. Eight patients underwent fMMC repair at 22-25 weeks gestation. Rehearsal placode dissection time (median 4min, range 2-8), and individual suture time (median 9.2min, range 5-19) are shorter than actual fMMC surgical times (median placode dissection 16min, range 8-36; p=0.003 and median suture time 17min, range 5-77; p<0.001, respectively). Total fetoscopy time (median 202 min, range 161-324) is comparable to other fetoscopic techniques. Simulation sessions were critical for identification of issues with instrumentation, sliding knots, and technique without the time pressure in the actual procedure. All fMMC repairs accomplished complete closure of the defect and no revisions were required postnatally. There were no unanticipated intraoperative technical events that were not encountered during simulation sessions. We report successful performance of 2-port fMMC repair, complemented by procedure specific surgical rehearsal using ultrasound derived 3D printed models in a newly established program. The primary benefit of surgical rehearsal was the harmonisation of two operators and anticipation of intraoperative challenges for the successful completion of surgery. Longer total operative times may reflect learning curves for intraoperative factors that are inadequately represented in the simulated setting. Concurrent clinical practice and repetitive surgical rehearsal provides an opportunity to strategically target ways to improve surgical efficiency.
DOI: 10.1002/uog.19303
Institution: Johns Hopkins University
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2897192599