Eastern Cardiothoracic Surgical Society

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A Simplified Low-Cost Simulator for Minimally Invasive Cardiac Surgery Training
Ahmed Alnajar1, P. Alex Smith, Ph.D.2, Swaminadhan Gnanashanmugam, MD3, Asma Aljesrawi4, Marcos Garcia Salas1, Joseph Lamelas, MD1.
1University of Miami, Miami, FL, USA, 2Texas Heart Institute, Houston, TX, USA, 3Baylor College of Medicine, Houston, TX, USA, 4The University of Jordan, Amman, Jordan.

OBJECTIVE:
Minimally invasive surgery often have demonstrated exceptional clinical outcomes after surpassing the learning curve. However, limited training opportunities have slowed its adoption. We aim to develop a low-cost simulator as a platform for trainees to develop a sense of familiarity with minimally invasive techniques, outside the stressful environment of an operating room.
METHODS:
We constrained ourselves to only using components commonly available at most hospitals, so it can be replicated by any surgical trainee, no matter their budget. Our model comprises a skeleton, a cup, rubber tubing, and expired grafts and sutures. The model was oriented to replicate patient position and lighting in the operating room. We recommend training with long shafted instruments to simulate the actual procedure. Trainees practiced on the model and were timed while fulfilling different roles in various procedures.
RESULTS:
We constructed a field for suture training inside the thorax. Minimally invasive access was created with towels, approximating the confined workspace and the visibility of a mini-thoracotomy. In its simplest form, this training system can be used to practice suturing with limited access.
CONCLUSIONS:
Several trainees (students, residents, and fellows) were able to complete certain anastomoses within a shorter time frame and more accuracy with repetition. This demonstrated an enhanced understanding of surgical techniques within a limited access environment. It is possible to simulate more complicated procedures by incorporating anatomic structures, such as valves; this would incur additional cost but may be justified as trainee skills advance.


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