Simulation in cardiothoracic surgical training: Where do we stand?

Trehan, Kanika; Kemp, Clinton D.; Yang, Stephen C.

doi:10.1016/j.jtcvs.2013.09.007

“…Currently, due to the difficulties to obtain and use cadavers, ethical issues and significant anatomic differences between animals and humans 1 - 3 , new methods to teach surgical techniques have been pursued such as the use of artificial simulators [ 4 ] .…”

Section: Introductionmentioning

confidence: 99%

Low Cost Simulator for Heart Surgery Training

Silva¹,

Lourenção²,

Goncharov³

et al. 2016

Brazilian Journal of Cardiovascular Surgery

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ObjectiveIntroduce the low-cost and easy to purchase simulator without biological material so that any institution may promote extensive cardiovascular surgery training both in a hospital setting and at home without large budgets.MethodsA transparent plastic box is placed in a wooden frame, which is held by the edges using elastic bands, with the bottom turned upwards, where an oval opening is made, "simulating" a thoracotomy. For basic exercises in the aorta, the model presented by our service in the 2015 Brazilian Congress of Cardiovascular Surgery: a silicone ice tray, where one can train to make aortic purse-string suture, aortotomy, aortorrhaphy and proximal and distal anastomoses. Simulators for the training of valve replacement and valvoplasty, atrial septal defect repair and aortic diseases were added. These simulators are based on sewage pipes obtained in construction material stores and the silicone trays and ethyl vinyl acetate tissue were obtained in utility stores, all of them at a very low cost.ResultsThe models were manufactured using inert materials easily found in regular stores and do not present contamination risk. They may be used in any environment and maybe stored without any difficulties. This training enabled young surgeons to familiarize and train different surgical techniques, including procedures for aortic diseases. In a subjective assessment, these surgeons reported that the training period led to improved surgical techniques in the surgical field.ConclusionThe model described in this protocol is effective and low-cost when compared to existing simulators, enabling a large array of cardiovascular surgery training.

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“…1 However, advanced surgical skills simulators are generally expensive and require extensive setup time. 2 The use of commercially available simulation systems that cost >$500 USD per use represents a significant financial burden for many centers that are establishing an ECLS program.…”

mentioning

confidence: 99%

Novel ECMO surgical cannulation simulators

McMullan

¹

2017

Qatar Medical Journal

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“…

We read with interest the recent article 'Preoperative simulation of minimally invasive aortic valve replacement using patient-specific replica' by Murakami and colleagues which describes the development of patient-specific replicas to guide preoperative planning during minimally invasive aortic valve replacement [1].As early as the 1800s, surgeons have used simulation training to hone their skills, practicing on animals and cadavers [2]. In the past decade, simulation has developed rapidly, and in the UK, a portfolio of 'bootcamp' courses is now offered throughout specialisation targeting skills relevant to each stage of training.

…”

mentioning

confidence: 99%

“…High-fidelity computer-programmed models do not offer live tissue but do provide real-time physiology and repetition. There have been calls for a standardised way to assess simulation models as compared to the traditional apprenticeship model popularised by Halstead in the early twentieth century [2]. Perhaps, an integrated approach in which each simulator is used at an appropriate time to complement apprenticeship training would be a powerful form of multi-faceted training.…”

mentioning

confidence: 99%

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Patient-specific simulation: a new avenue to be explored

Wood

¹

,

Kenny

²

2017

Gen Thorac Cardiovasc Surg

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We read with interest the recent article 'Preoperative simulation of minimally invasive aortic valve replacement using patient-specific replica' by Murakami and colleagues which describes the development of patient-specific replicas to guide preoperative planning during minimally invasive aortic valve replacement [1].As early as the 1800s, surgeons have used simulation training to hone their skills, practicing on animals and cadavers [2]. In the past decade, simulation has developed rapidly, and in the UK, a portfolio of 'bootcamp' courses is now offered throughout specialisation targeting skills relevant to each stage of training. This development has been motivated by changing attitudes towards patient safety and the surgical 'learning curve' as well as limitations in trainee exposure due to the high-risk nature of the speciality, the infrequency of many presentations, and constraints of the European Working Time Directive [3,4]. The online publication of surgeons' mortality rates may have further impacted training opportunities [5]. The appeal of standardised training without a risk to patient safety is clear.There is ongoing debate about the optimum form of simulation as every model, by nature, is a compromise. Replicas, including patient-specific models, offer pathology but are limited by their representation of tissue; conversely, cadaveric or animal tissue-based models offer excellent tissue quality but little pathology [1]. High-fidelity computer-programmed models do not offer live tissue but do provide real-time physiology and repetition. There have been calls for a standardised way to assess simulation models as compared to the traditional apprenticeship model popularised by Halstead in the early twentieth century [2]. Perhaps, an integrated approach in which each simulator is used at an appropriate time to complement apprenticeship training would be a powerful form of multi-faceted training. High-quality studies assessing longterm impact on trainee performance and patient safety will be central in enabling provision of safe and evidence-based training for the next generation of cardiac and thoracic surgeons.

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Simulation in cardiothoracic surgical training: Where do we stand?

Abstract: Surgical simulation is becoming an increasingly important educational tool in training cardiothoracic surgeons. Our next steps forward will be to develop an objective, standardized way to assess surgical simulation training compared with the current apprenticeship model.

Cited by 91 publications

References 55 publications

Low Cost Simulator for Heart Surgery Training

Low Cost Simulator for Heart Surgery Training

Novel ECMO surgical cannulation simulators

Patient-specific simulation: a new avenue to be explored

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