International Society for Minimally Invasive Cardiothoracic Surgery
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Lowering Thresholds And Learning Curves In Minimal Invasive Coronary Artery Bypass Grafting.
Michiel Algoet, MD1, Alfonso Agnino, MD2, Asciano Graniero, MD2, Claudio Roscitano, MD2, Wouter Oosterlinck, MD, PhD1.
1Department of Cardiovascular Sciences, Research Unit of Cardiac Surgery, Leuven, Belgium, 2Division of Robotic and Minimally Invasive Cardiac Surgery, Cliniche Humanitas Gavazzeni, Bergamo, Italy.

BACKGROUND: Cardiac surgery is a constantly innovating field. The growing amount of minimal invasive strategies require constant training and education. Interaction between peers is crucial in this field to become a better surgeon and avoid pitfalls. Although proctoring is time consuming and requires an effort of the trainer, evolution of virtual support during the COVID-19 pandemic has brought solutions to lower these thresholds.
METHODS: The proctoring course starts with dry- and wetlab trainings at a dedicated training center. In a next step the whole cardiac surgery team observed RA-MIDCAB surgeries performed and commented by the proctor on a remote site, using virtual assistance with the remote support technology using smartglasses. From here conventional on-site training was performed with training in the proctorís center and afterwards in the starting center. In a last phase the starting center performed a RA-MIDCAB procedure independently with remote guidance of the proctor using the Smartglass technology (Figure 1).
RESULTS: The RA-MIDCAB trainee, which was a trained OPCAB surgeon, was able to perform an independent case in 2 virtual and 2 live training days. On day 5, an independent case was succesfully performed by the RA-MIDCAB trainee with remote live guidance of the proctor. Positive feedback obtained during the observations days regarding full visibility of the surgical field and interaction with the trainer for the trainee and team. From a trainers perspective there was the advantage of being able to give real time advice without being on site, a higher time effectiveness and lower travel costs.
CONCLUSIONS: Proctoring in cardiac surgery is an important part of maintaining the best healthcare for our patients. With the use of the remote support technology using smartglasses we can set up a partially remote and virtual assisted training program. The system can be used for both trainee and trainer flattening the learning curve and lowering thresholds to start and continue independent cases. The whole setup emphasizes the possibility of an efficient training for a trainee and his/her team with maximal time efficiency.LEGEND: Figure 1: Overview screen for the proctor during remote live guidance. A: Robotic view, B: Surgeonís view, C: Operating field overview, D: Proctorís webcam.


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