Individually tailored training to improve less invasive coronary surgery

Abstract

Background: Minimal invasive coronary surgery has been criticized for being unsafe and lack of dispersion. To allow an individually tailored training and improve dispersion, training models and self-evaluation are needed. We wanted to build a realistic beating heart model and scoring system to allow a surgeon to evaluate his skills and limitations in minimal invasive coronary surgery and to use it at training model for both Off Pump Coronary Artery Bypass Surgery (OPCAB) and Minimal Invasive Direct Coronary Artery Bypass Surgery (MIDCAB) procedures. Methods: We used a beating heart model (CABG HEARTS #1259, The Chamberlain group, Great Barrington, MA, USA) and installed it in a dedicated box or skeleton to mimic the spatial limitations in OPCAB and MIDCAB. 5 fellows and 5 residents were enrolled and trained single coronary anastomosis with beating heart techniques. Pig ureters were used as grafts, and plastic tubes (1.75mm) were used as target vessels. Before and after the training, subjects were evaluated for anastomotic time, leakage, shape, flow measurement and personal appreciation of their work. Each aspect has a score from 1 to 5 points (full marks; 25points) and total scores were calculated afterwards. The significance was evaluated using Wilcoxon rank sum test and the Mann-Whitney test. Results: In all 10 cases, median score increased significantly from 15.5[12-18] to 18.5[17-20], P=0.03. Total score was different between fellows and residents pre-exercise (12vs18, P=0.01), but no longer after 3 initial training sessions (17vs19, P=0.29). Anastomosis times decreased significantly in the resident group (27min to 18min, P=0.05) but not in fellow group (14min to 18min, P=0.59). Evaluating only the objective parameters by an observer confirms the rapid learning in residents, but plateau phase in the already more skilled fellows. Conclusions: With this beating heart anastomosis model we can evaluate pre-training skills and improve test scores by incremental learning. In young residents this increases their performance quickly to a level of fellow trainees. Subsequently, the more experienced fellow can continue to use it in a more challenging minimal invasive environment to continuously further improve their anastomotic skills.status: accepte