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Setting Up A Minimally Invasive Cardiac Surgery Program With Novice Team. A Systematic Approach
Qasim Al abri1, Ziyab K. Sarfaraz
1, Mohammed Y. Bekkouch
1, Utba Al Manthri
1, Mahesh K. Ramchandani
2;
1National Heart center, Muscat, Oman,
2Houston METHODIST HOSPITAL, HOUSTON, TX, USA
OBJECTIVE: We describe in the study our methodology for preparing a team who had not been exposed to minimally invasive cardiac surgery (MICS) to start a fully functional, efficient, and safe MICS program
METHODS: A written proposal was submitted to the administration of the heart center outlining the objectives and requirements for starting a MICS program. This was followed by a grand round about MICS for all concerned departments. Surgical instruments and disposable items were ordered. Once all the necessary items were received, a team from all concerned departments was selected. The team included surgical assistants, anesthesiologists, perfusionists, scrub nurses, and circulating nurses. The team's preparation began with exposure to an online video tutorial about setting up for minimally invasive surgery. The second stage of preparation involved familiarizing the team with the instruments and minimally invasive surgical setup in the context of a conventional open-heart surgery. This included performing double-lumen intubation, femoral cannulation with wire and echo guidance, and optimizing cardiopulmonary bypass through peripheral cannulation. Del Nido cardioplegia solution was also introduced for the first time in an open surgical case in preparation for use when the minimally invasive program started. During this stage, individual meetings were held with all concerned departments to provide feedback and address their concerns. 10 patients were selected with various pathologies and demographics to familiarize the team with more challenging situations and potential troubleshooting.
RESULTS: The cases were performed by a single MICS trained surgeon under the proctorship of an experienced surgeon. All cases were successfully done via MICS approach without any conversions. There were no adverse events. Only 1 patient required a blood transfusion. Average ICU length of stay was 14 hours and a majority of patients were discharged on post-operative day 3. We also focused on monitoring team efficiency and turnover. The results are summarized in table 1.
CONCLUSIONS: Our innovative training strategy transformed a novice team into a competent MICS unit, demonstrating its effectiveness in resource-constrained settings. Adapting this model empowers similar teams globally, democratizing access to advanced cardiac care.
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