James I. Fann, MD, Richard H. Feins, MD, George L

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Presentation transcript:

Evaluation of simulation training in cardiothoracic surgery: The Senior Tour perspective James I. Fann, MD, Richard H. Feins, MD, George L. Hicks, MD, Jonathan C. Nesbitt, MD, John W. Hammon, MD, Fred A. Crawford, MD The Journal of Thoracic and Cardiovascular Surgery Volume 143, Issue 2, Pages 264-272.e9 (February 2012) DOI: 10.1016/j.jtcvs.2011.10.013 Copyright © 2012 Terms and Conditions

Figure 1 A, Small vessel anastomosis: Mounted in the portable chest model are synthetic target vessels; to simulate vein graft for the anastomosis, synthetic vessels are used. For the tissue-based or “wet-laboratory” component, porcine hearts are prepared and positioned to expose the left anterior descending artery in a container. B, Aortic cannulation: A porcine descending thoracic aorta is secured in a plastic thoracic model. The pressurized ascending aorta allows placement of purse-string sutures followed by placement of aortic cannula; because of the length of aorta, multiple cannulations are performed. C, Cardiopulmonary bypass: The plastic container with a porcine heart model and inflow and outflow lines are part of the simulator. The system simulates multiple physiologic conditions during cardiopulmonary bypass. A, Aortic cannula; V, atrial cannula; P, cardioplegia line. The Journal of Thoracic and Cardiovascular Surgery 2012 143, 264-272.e9DOI: (10.1016/j.jtcvs.2011.10.013) Copyright © 2012 Terms and Conditions

Figure 2 A, Hilar dissection: A porcine heart–lung block placed within the chest cavity of a mannequin simulates the necessary maneuvers of hilar dissection through a thoracotomy incision. B, Esophageal anastomosis: A porcine heart–lung–esophagus block simulates the thoracotomy incision providing access to the posterior mediastinum. The esophagus is isolated, transected, and reapproximated in 1 or 2 layers. C, Rigid bronchoscopy: By using conventional bronchoscopic equipment, the Trucorp AirSim model (Belfast, North Ireland) simulates the tracheobronchial tree. L, Lung; H, hilum; E, esophagus; TE, tracheoesophageal segment. The Journal of Thoracic and Cardiovascular Surgery 2012 143, 264-272.e9DOI: (10.1016/j.jtcvs.2011.10.013) Copyright © 2012 Terms and Conditions

Figure 3 A, Aortic valve replacement: For the tissue-based aortic valve replacement simulator, porcine hearts are placed in the container and situated to present the ascending aorta and aortic root. The aortotomy is made followed by excision of the leaflets and implantation of the aortic valve. B, Mitral valve repair: The synthetic mitral valve model is placed in a portable chest model. For the tissue-based simulator, porcine hearts are placed in the container and situated to present the mitral valve. The left atrium is retracted to expose the mitral valve and annuloplasty performed. C, Aortic root replacement: For the tissue-based aortic root replacement simulator, porcine hearts are placed in the container. The porcine aorta and root are resected after creation of the coronary ostial buttons. An aortic homograft is anastomosed as a root replacement. LA, Left atrial wall; AL, anterior leaflet; PL, posterior leaflet. The Journal of Thoracic and Cardiovascular Surgery 2012 143, 264-272.e9DOI: (10.1016/j.jtcvs.2011.10.013) Copyright © 2012 Terms and Conditions

Figure 4 A, VATS lobectomy: A left porcine heart–lung block placed within the chest cavity of a mannequin is accessed via working ports to allow for video-assisted resection. B, Tracheal resection: A porcine tracheal-esophageal segment placed within the open neck of a mannequin simulates tracheal resection and anastomosis. C, Sleeve resection: A porcine heart–lung block placed within the chest cavity of a mannequin (similar to the hilar dissection model) simulates the necessary maneuvers of sleeve resection. T, Trachea; An, anastomosis. The Journal of Thoracic and Cardiovascular Surgery 2012 143, 264-272.e9DOI: (10.1016/j.jtcvs.2011.10.013) Copyright © 2012 Terms and Conditions

The Journal of Thoracic and Cardiovascular Surgery 2012 143, 264-272 The Journal of Thoracic and Cardiovascular Surgery 2012 143, 264-272.e9DOI: (10.1016/j.jtcvs.2011.10.013) Copyright © 2012 Terms and Conditions

The Journal of Thoracic and Cardiovascular Surgery 2012 143, 264-272 The Journal of Thoracic and Cardiovascular Surgery 2012 143, 264-272.e9DOI: (10.1016/j.jtcvs.2011.10.013) Copyright © 2012 Terms and Conditions

The Journal of Thoracic and Cardiovascular Surgery 2012 143, 264-272 The Journal of Thoracic and Cardiovascular Surgery 2012 143, 264-272.e9DOI: (10.1016/j.jtcvs.2011.10.013) Copyright © 2012 Terms and Conditions

The Journal of Thoracic and Cardiovascular Surgery 2012 143, 264-272 The Journal of Thoracic and Cardiovascular Surgery 2012 143, 264-272.e9DOI: (10.1016/j.jtcvs.2011.10.013) Copyright © 2012 Terms and Conditions

The Journal of Thoracic and Cardiovascular Surgery 2012 143, 264-272 The Journal of Thoracic and Cardiovascular Surgery 2012 143, 264-272.e9DOI: (10.1016/j.jtcvs.2011.10.013) Copyright © 2012 Terms and Conditions

The Journal of Thoracic and Cardiovascular Surgery 2012 143, 264-272 The Journal of Thoracic and Cardiovascular Surgery 2012 143, 264-272.e9DOI: (10.1016/j.jtcvs.2011.10.013) Copyright © 2012 Terms and Conditions

The Journal of Thoracic and Cardiovascular Surgery 2012 143, 264-272 The Journal of Thoracic and Cardiovascular Surgery 2012 143, 264-272.e9DOI: (10.1016/j.jtcvs.2011.10.013) Copyright © 2012 Terms and Conditions

The Journal of Thoracic and Cardiovascular Surgery 2012 143, 264-272 The Journal of Thoracic and Cardiovascular Surgery 2012 143, 264-272.e9DOI: (10.1016/j.jtcvs.2011.10.013) Copyright © 2012 Terms and Conditions

The Journal of Thoracic and Cardiovascular Surgery 2012 143, 264-272 The Journal of Thoracic and Cardiovascular Surgery 2012 143, 264-272.e9DOI: (10.1016/j.jtcvs.2011.10.013) Copyright © 2012 Terms and Conditions