Development and Evaluation of a High-FidelityCleft Palate Simulator forSurgeon Training and for Development of a Robotic Approach to Infant Cleft Palate Surgery

• Published in: Canadian journal of plastic surgery Vol. 25; no. 2; p. 111
• Main Authors: Podolsky, D J, Fisher, D M, Wong, K, Looi, T, Drake, J M, rest, C R
• Format: Journal Article
• Language: English
• Published: Montreal SAGE PUBLICATIONS, INC 01.07.2017
• Subjects: Plastic surgery; Robotics
• ISSN: 2292-5503; 2292-5511

Purpose: To develop and evaluate a cleft palate simulator to enhance training in cleft palate surgery and to act as a test bed for the development of a novel robotic instrument specifically designed for infant cleft palate surgery. Method: A highfidelity cleft palate simulator was developed from patient imaging, 3D printing, polymer and adhesive techniques. The simulator was evaluated by having 3 residents perform 5 and 1 resident perform 9 endoscopic video recorded cleft palate repairs. Two experts assessed the videos using a newly developed cleft palate specific technical assessment tool and global rating scale. The simulator workspace guided development of a novel robotic instrument wrist that couples to the da Vinci surgical system. A friction testing rig was used to determine the increased cable tension due to the wrists novel cable guide channels. Results: The average performance of the residents increased logarithmically (cleft specific scale, R2 = .9925, P = .000; global scale, R2 = .982, P = .000) after each successive simulation session. Reliability of the cleft specific assessment tool amongst the raters was high (average item ICC = 0.85 + 0.093, Cron a = 0.86 + 0.086). The novel robotic instrument has more compact articulation within the infant oral cavity compared to existing da Vinci instruments. However, the guide channels introduce up to 40% more cable tension at a wrist pitch angle of 90°. The increased cable tension is sensitive to the cable groove pattern and the groove perimeter angle. Conclusions: A new cleft palate specific technical assessment tool was validated. Technical proficiency improves with repetitive use of the cleft palate simulator. The novel robotic instrument facilitates more compact articulation within the infant oral cavity at the expense of increased cable tension. Learning Objectives: Participants will gain an understanding of the methods of evaluating surgical simulators and the development and testing of a novel robotic instrument for infant cleft palate surgery.