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Beating Ball in a Box - A Low Cost Multifunctional Device for OPCAB Training
Hassina Baraki, Shunsuke Saito, George Kensah, Julia Dahlmann, Bernhard Fleischer, Patrick Zardo, Ingo Kutschka.
Otto-von-Guericke University Magdeburg, Magdeburg, Germany.

OBJECTIVE: Simulation provides the opportunity to improve technical skills outside the operating room. Our aim was to build a simple, cost-effective, multi-purpose device for training and education in off pump coronary artery bypass surgery (OPCAB).
METHODS: The device is made of an aluminium box (40cm x 25cm x 25cm) with an open top side. Inside the box we mounted a rubber ball with a diameter of 15 cm, which is connected to an electrically powered air pump (ventilator). The rubber ball can be inflated rhythmically by the ventilator, simulating a beating heart. Displaced volume (stroke volume) and frequency of the pulsatile inflation (40-120 bpm) can be changed to advance training conditions. Furthermore, two accessory box walls can be moved towards the ball, which allows for a gradual reduction of the free moving space of the surgeon. Mechanical stabilizers (e.g. used disposable devices, free of charge) can be mounted on special rails at the upper rim of the box. Disposable silicon surgical tubes in several sizes (1.5-3.0mm) are used as vessel conduits. They can be mounted on the rubber ball in various locations using tape stripes.
RESULTS: This small and portable simulator allows for education and training of the whole range of modern coronary surgery. It provides a realistic simulation for OPCAB and minimally invasive coronary surgery including several levels of difficulty by modification of the beating frequency, beating volume, free moving space and vessel size.
All instruments and suture materials can be placed inside the small box for easy storage and transportation. Due to the simple design of the device a reasonable pricing can be achieved.
CONCLUSIONS: This simulator represents a new innovative tool for training and teaching of OPCAB surgery in a realistic setting. Its manufacturing is simple and cost effective. It may contribute to improve training programs and learning curves.

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