Novel Educational App For Minimally Invasive Esophagectomy
Joseph A.R. Ojah1, Ahmad S. Ashrafi2, Ajmal Hafizi3.
1University of British Columbia, Vancouver, BC, Canada, 2Fraser Health Authority, Surrey, BC, Canada, 3Surrey Thoracic Surgery Group, Surrey, BC, Canada.
BACKGROUND - The learning curve for the complex surgical procedure known as Minimally Invasive Esophagectomy (MIE) is steep and current case allocation per surgeon across Canada is relatively low, thus impairing achievement of mastery in MIE. Alternative training experiences are expensive and resource-intensive. Shift towards adopting MIE has been slow since its inception in 1993. This educational app has been designed to overcome challenges in adoption by systematically teaching port placement, instrument utilization, and the dynamics of the procedure. Simplifying and clarifying the complex MIE into succinct learning modules facilitates learning at all levels. Thus, we endeavor to introduce a locally-developed, multi-modal teaching app to ease transition to MIE by attending thoracic surgeons and provide enhanced pre-operative preparation for junior trainees. Currently, no other such learning application is available.
METHODS - Industry-standard photographic, digitizing and 3D modelling software was used to integrate all instruments, patient mannequin positions and operative room facilities into the components of the App. To distill the entire procedure, subdivision into laparoscopic and thoracoscopic phases has been done, with further minor segments within each section, all comprising the systematic steps of MIE. Parallel, correlative, output from detailed descriptive text atlas, high resolution intra-operative video and instrument simulation components converge to generate a helpful, multi-modal guide for operative setup and intra-operative maneuvers. 
RESULTS - Embedded assessment tools objectively evaluate the user's facility with descriptive atlas assimilation, correct port placement strategy and instrument dynamics throughout phases of the operation.
CONCLUSIONS - Surgeons are under significant pressure to continually improve and learn new skills. The steep MIE learning curve translates into morbidity during earlier cases. Compatible with multiple mobile platforms (PC/MAC, Android, iOS), this reliable, peer-reviewed App allows convenient out-of-OR complete and repetitive rehearsal of all operative phases. Important features include emphasis on strategic operative setup of ports and instrument utilization and dynamics, which can be self-evaluated and improved upon, facilitating precise dissection and accurate reconstruction in patients. Real-time App projection in the operating room is beneficial. Acceleration of the MIE learning curve will result in superior esophagectomy patient outcomes.
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